What Michigan’s Statute Permits: ABA Age and Dollar Limits
This is what the statute text permits. Whether your plan uses these limits is a separate question, covered on the pages that follow.
The permitted limits
Age
An insurer may limit autism treatment coverage to an insured or enrollee through 18 years of age. The word is may, so it is a permission.
Annual maximums
Where an insurer applies a maximum annual benefit, the statute lists $50,000 through age 6, $40,000 from age 7 through 12, and $30,000 from age 13 through 18.
Both statutes say it
Section 416e uses the same figures for health care corporation certificates, and the state autism program says coverage may be limited through age 18.
The policy controls
Because the statute is permissive, the language in the certificate decides whether a limit applies. Read it, then ask the carrier.
Back to the ABA guide.
What Michigan’s Statute Permits: ABA Age and Dollar Limits: short answers
What are the ABA dollar caps in the statute?
$50,000 a year through age 6, $40,000 from 7 through 12 and $30,000 from 13 through 18, if the insurer applies a maximum.
Is the age 18 limit mandatory?
No. The statute says an insurer may limit coverage through age 18. Some policies do, some do not.
Do these limits still apply in practice?
The state regulator and the House Fiscal Agency indicate annual dollar limits are not enforceable. See the pages on the regulator’s position and the federal annual limit rule.
What Michigan’s Statute Permits: ABA Age and Dollar Limits: not legal advice. Send us your renewal.
Where these details come from
The laws and rules named on this page link to the official text. This is general information, not legal advice, and rules change, so check the current text.
MCL 500.3406s, Insurance Code of 1956
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