ABA Coverage in Self-Funded Plans in Michigan
A self-funded employer has more freedom on ABA and more responsibility to decide.
Why self-funded plans differ
Outside state mandates
The state autism program and DIFS both say self-funded ERISA plans are not regulated by the state and are not required to provide autism coverage.
The plan document controls
Definitions, exclusions, authorization steps and any age or dollar limits all come from the plan document, so that is where to look.
Coverage is a choice
Some self-funded plans cover ABA. The sponsor decides which services, ages and visit rules apply, and should write them down in plain language for employees.
A state program may apply
The Autism Coverage Reimbursement Act treats a group health plan sponsor as a carrier that can apply to a state reimbursement program, subject to funding.
Back to the ABA guide.
ABA Coverage in Self-Funded Plans in Michigan: short answers
Do we have to cover ABA if we self-fund?
Not under Michigan law. ERISA keeps self-funded plans outside state insurance mandates. Federal rules such as parity may still apply.
How do we find out what our plan covers?
Read the plan document and summary plan description, and ask the administrator how autism claims are handled today.
Should we add ABA coverage?
That is a plan design choice. Weigh it with your adviser and counsel, including stop-loss implications.
ABA Coverage in Self-Funded 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.
State of Michigan: Autism Legislation
DIFS: Autism Spectrum Disorder Health Coverage
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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.
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