Matching the Plan Document to ABA Coverage
The plan document is the controlling text for a self-funded plan.
What to confirm in the documents
The controlling text
A self-funded plan’s plan document controls autism coverage because the state mandate does not apply.
Summary plan description
The SPD should describe ABA coverage, authorization and limits in language participants can follow.
Consistency
Compare the plan document, the SPD, the stop-loss contract and the administrator’s practice for gaps.
Update the document
If the document is silent or unclear, ask the administrator and counsel whether the plan should be clarified.
Back to the ABA guide.
Matching the Plan Document to ABA Coverage: short answers
Is a benefits guide enough?
No. A benefits guide is not a plan document or an SPD.
Who should review it?
Your counsel and your administrator, with your adviser.
What if claims are being paid without a clear provision?
Ask counsel how to document the practice and whether to amend the plan.
Matching the Plan Document to ABA Coverage: 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.
State of Michigan: Autism Legislation
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