How to Read Your Plan Certificate for ABA Coverage
ABA coverage can be described in more than one section. Read them together.
What to look for
Find every section
Check the autism, applied behavior analysis, behavioral health, therapy and developmental condition sections together, since coverage can appear in more than one place.
Definitions
Compare the plan’s definition of ABA, behavioral health treatment and provider with the statutory definitions.
Conditions
Note any diagnosis, treatment plan, authorization and reauthorization steps, and any age or dollar language.
Exclusions
Look for exclusions of services by family or household members, educational services, and anything that conflicts with the statute.
Back to the ABA guide.
How to Read Your Plan Certificate for ABA Coverage: short answers
What if the certificate is silent on ABA?
Ask the carrier to confirm in writing how ABA is covered. The statute applies to insured plans even if the document is vague.
What if it limits coverage more than the statute?
Ask the carrier to explain and have counsel review. DIFS accepts complaints.
Where do we keep the answer?
Save the carrier’s written response with the plan file and share it with the HR staff who field employee questions.
How to Read Your Plan Certificate for 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.
MCL 500.3406s, Insurance Code of 1956
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