ABA Visit Limits and Educational Exclusions in Michigan
Two prohibitions in the statute matter most to families: no visit caps, and no denial because the treatment is educational or habilitative.
What insurers cannot do
No visit limits
An insurer may not limit the number of visits an insured or enrollee may use for covered autism treatment. The same bar appears in the health care corporation statute.
No educational or habilitative exclusion
Coverage cannot be denied or limited on the basis that treatment is educational or habilitative in nature. This is why ABA, which builds skills, is not excluded as education.
Medical management is still allowed
Insurers may use evidence-based care, utilization review including medical necessity review, and case management. A review is not a visit cap, but a pattern of denials can act like one.
DIFS reads it the same way
The state insurance regulator lists limiting visits for any mandated treatment, and denying coverage as educational or habilitative, among prohibited limits.
Back to the ABA guide.
ABA Visit Limits and Educational Exclusions in Michigan: short answers
Can a plan limit ABA to a set number of hours or visits?
Not by a fixed visit cap. The statutes bar limiting the number of visits for covered autism treatment. Authorization and medical necessity review still apply.
Can a plan deny ABA because it is educational?
No. The statutes say coverage cannot be denied or limited on the basis that treatment is educational or habilitative in nature.
Does this apply to self-funded plans?
No. Self-funded plans sit outside state insurance mandates, so the plan document decides.
ABA Visit Limits and Educational Exclusions 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.
MCL 500.3406s, Insurance Code of 1956
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