ABA Coverage in Fully Insured Group Plans in Michigan
If your employer plan is bought from an insurance company in Michigan, the autism mandate applies to it.
How the mandate reaches an insured plan
Who is covered
DIFS says fully insured group health policies and certificates issued in Michigan must provide autism benefits, along with all individual plans. A fully insured plan is one the employer buys from an insurance company.
Both statutes
Commercial insurers and HMOs follow section 3406s of the Insurance Code. Blue Cross Blue Shield of Michigan certificates follow section 416e of the nonprofit health care corporation act.
Policies issued outside Michigan
Public Act 100 applies to policies delivered, issued or renewed in Michigan, or outside it if they cover Michigan residents.
What to ask the carrier
How the mandate appears in the certificate, what documentation families must supply, and what age, authorization and provider rules the carrier applies.
Back to the ABA guide.
ABA Coverage in Fully Insured Group Plans in Michigan: short answers
Does the mandate apply to small group and large group?
Yes. DIFS lists fully insured group policies without a size distinction, and Autism Speaks lists both large and small group fully insured plans as covered.
How do I know if we are fully insured?
Check whether the carrier bears claim risk under a policy or certificate. If the employer pays claims and buys stop-loss, the plan is self-funded.
What if the certificate seems to conflict with the statute?
Ask the carrier to explain in writing and have counsel review. DIFS accepts consumer complaints.
ABA Coverage in Fully Insured Group Plans 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.
DIFS: Autism Spectrum Disorder Health Coverage
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. →