Why ABA Annual Dollar Limits Are in Question in Michigan
The statute lists annual maximums, but several sources say they no longer apply in fully insured plans. Here is the reasoning.
How the caps lost force
Federal rule
Federal law generally prohibits annual limits on essential health benefits, for plan years beginning after January 1, 2014.
ABA is an essential benefit in Michigan
DIFS says ABA is categorized as a habilitative service in Michigan’s essential health benefits, and habilitative services are an essential health benefit category.
What the House Fiscal Agency said
Its fiscal forum describes the annual dollar limits specified in Public Act 100 as unenforceable because autism treatment, including ABA, is now within the essential health benefits.
The 2014 bulletin
Autism Speaks reports that on April 18, 2014 the state removed annual dollar limits for fully insured plans in bulletin 14-017-M. We have not located the bulletin text itself.
Back to the ABA guide.
Why ABA Annual Dollar Limits Are in Question in Michigan: short answers
Can my insurer still apply a $50,000 cap?
The statute permits it, but the regulator and the House Fiscal Agency indicate annual dollar limits are unenforceable. Get the carrier’s autism provision in writing.
Does the federal annual limit rule apply to self-funded plans?
The federal rule covers group health plans and issuers, but a self-funded plan is not required to cover ABA, so the practical effect depends on what the plan chooses to cover.
Should we rely on this page?
No. It is general information. Have counsel review how the statute, the federal rule and the regulator’s guidance apply to your policy.
Why ABA Annual Dollar Limits Are in Question in Michigan: 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.
Michigan House Fiscal Agency: Autism Spectrum Disorder fiscal forum
42 U.S.C. 300gg-11 (no lifetime or annual limits)
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
An independent employee benefits consulting firm. We look at the entire benefits program: cost, plan performance, risk and administration.
Switch to CFH. Unhappy with your broker? Your employees won’t notice. You will. →