Michigan Autism Insurance Mandate: What Employers Need to Know
What state law requires insured plans to cover for autism, where age limits and caps apply, and how self-funded plans differ.
What The Mandate Requires
A state requirement for insured plans, found in the Insurance Code.
MCL 500.3406s
Section 3406s of the Michigan Insurance Code requires coverage for autism spectrum disorder diagnosis and treatment.
2012 Reform
The autism insurance reform acts, Public Acts 99 and 100 of 2012, took effect October 15, 2012.
Later Amendment
The section was amended by Public Act 276 of 2016.
Applied Behavior Analysis
Treatment coverage includes applied behavior analysis, commonly called ABA. Employers reading plan documents should look at how the plan describes ABA, including any pre-authorization steps, provider requirements and visit or approval rules. Coverage details vary by plan, so check the certificate and ask the carrier.
Who Provides Care
Behavior analyst licensing laws, Public Acts 403 and 404, took effect January 3, 2018.
Insured Plans Only
The mandate is a state insurance law. It applies to insured plans issued in Michigan, not to self-funded plans. Employers that self-fund should not assume the same rules apply, because their plan document controls. Ask counsel and your adviser how your funding arrangement affects coverage, and whether the plan chooses to cover autism treatment.
Age Limits And Annual Caps In The Statute
The statute allows limits. Whether your plan uses them is a policy question.
Insurers May Limit By Age
The statute says an insurer may limit coverage for members through 18 years of age. The language is permissive. Plans and carriers can differ in how they apply age limits, so read the policy language rather than assuming. Employees with older children may have different options, and counsel can advise on how this applies to your plan.
What the State’s Own Pages Say
The state autism site says coverage may be limited through 18 years of age, which matches the statute. The insurance regulator’s consumer page says insurers cannot subject coverage to age limits or annual dollar limits. The two do not agree. Federal rules that bar annual dollar limits on essential health benefits may explain the stricter message for individual and small-group plans, but that is our reading, not the state’s statement. Ask your carrier for its autism provision in writing.
Annual Maximums
Where an insurer applies maximums, the statute lists 50,000 dollars through age 6, 40,000 dollars for ages 7 through 12, and 30,000 dollars for ages 13 through 18.
Cost Sharing
Cost sharing on autism benefits generally should not be more restrictive than for other medical care. Confirm with your carrier. Compare copays, coinsurance and any visit-based rules for autism services with those for other medical care in the same plan. If something looks tighter, ask the carrier to explain it and have counsel review.
Sources Differ
The state insurance regulator’s consumer page says insured plans may not apply age or annual dollar limits, while the statute text lets insurers limit coverage through age 18 and apply annual maximums by age. We have not seen the two reconciled, so ask your carrier what applies to your policy and ask counsel how the statute and the regulator’s guidance apply to your plan.
Pending Bill
House Bill 4740, introduced in July 2025, would amend the section. It is in committee and is not law.
Confirm In Writing
Ask the carrier to confirm age limits, caps and visit rules in writing. Save the response with your plan file and share it with HR staff who field employee questions. A written answer gives everyone the same reference and avoids confusion if a claim is disputed later.
Insured Versus Self-Funded
ERISA draws the line.
Fully Insured Group Plans
Fully insured group plans issued in Michigan must follow the mandate. Employers with fully insured coverage can ask the carrier how the mandate is reflected in the certificate and what documentation families need to provide. Counsel can help if the policy language and the statute seem to differ.
Self-Funded Plans
Self-funded ERISA plans are not regulated by the state and are not required to provide autism coverage under it. That means a self-funded employer has more flexibility, and also more responsibility to decide what its plan will do. Ask counsel how your plan document and funding arrangement affect autism coverage before you answer employee questions.
Many Self-Funded Plans Cover It Anyway
Plan sponsors choose coverage. Many include autism benefits, but the terms are up to the plan. If your plan covers autism services, confirm which services, age ranges and visit limits apply, and write them down in plain language for employees. If it does not, discuss the choice with your adviser.
Ask For The Plan Document
A self-funded employer should read its plan document for autism limits. Look for definitions, exclusions, authorization steps and any age or dollar limits. If the document is silent or unclear, ask your TPA and counsel how claims are being handled today and whether the plan should be clarified.
Employees Often Ask
Families with a child on the spectrum often ask HR first, so know the answer. A short internal guide with the plan’s key terms, contacts and next steps helps HR respond with confidence. Employees appreciate a clear, kind answer, and managers should know where to refer sensitive questions.
What Employers Can Do
Practical steps for plan sponsors.
Review The Policy
Check the certificate of coverage for autism, ABA and age rules. Read the sections on behavioral health, therapy and developmental conditions together, since coverage can be described in more than one place. Note any definitions, referral rules or age limits, and ask the carrier to explain anything unclear.
Ask About Provider Access
Ask how many ABA providers are in network and how long the wait is. Network size and wait times affect whether families can actually use a benefit on paper. Ask the carrier for a provider directory sample and how out-of-network care is handled when in-network openings are scarce.
Check Authorization Rules
Ask what authorization and reauthorization the carrier requires. Requirements can include a treatment plan, periodic progress reviews and updated evaluations. Knowing the process in advance helps HR support families and prevents gaps in care when paperwork is due. Ask who handles reauthorization requests and how quickly the carrier responds.
Coordinate With Other Benefits
Look at how behavioral health, an employee assistance program and virtual care fit together. Families often use several resources at once, so a short guide explaining what each benefit does and how to reach it can help. Make sure the phone numbers and enrollment steps stay current.
Compare At Renewal
Use renewal to compare autism benefit terms across carriers. Ask each carrier to explain coverage, age rules, authorization steps and provider access in writing, using the same questions for all. Comparing the answers side by side helps you weigh benefit design alongside price.
What Employers Ask About Autism Coverage
Short answers to common questions.
Does Michigan require autism coverage?
Yes, for insured plans issued in Michigan, under MCL 500.3406s.
Does it apply to self-funded plans?
No. Self-funded ERISA plans are not required to provide the coverage under state law.
Does it cover ABA therapy?
Treatment coverage includes applied behavior analysis.
Is there an age limit?
The statute lets insurers limit coverage through age 18, but sources differ on whether insured plans may do so. Ask your carrier.
Are there dollar caps?
The statute lists annual maximums by age band that insurers may apply. Confirm what your policy does.
Has the law changed recently?
The section was last amended in 2016. A 2025 bill would amend it again but has not passed.
Does a small employer have to follow it?
The mandate applies to insurers, so it reaches fully insured small group plans issued in Michigan.
Who should we ask?
Your carrier and benefits advisor. We can help you request the details.
Is this legal advice?
No. This page is general information, not legal advice. Rules change and facts differ, so confirm your situation with your attorney or tax advisor.
Related Guides
Related reading: Michigan benefits compliance · Mental health parity · Behavioral and mental health · Group health insurance
The rules in one place.
Michigan Employer Benefit Laws
Wages, sick time, civil rights and coverage mandates, in one place.
Where the Rules Come From.
The laws and rules named on this page link to the statute or regulation they come from. This is general information, not legal or tax advice, and rules change, so check the current text.
ERISA (29 U.S.C. Chapter 18)
The federal law that sets reporting, disclosure and fiduciary rules for employer-sponsored benefit plans.
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. →
Cookies on This Site
We use cookies to keep the site working properly and to understand how it is used. You can decline anything that is not essential. See our Privacy Policy for the detail.
- Essential — needed for the site to load and for you to move around it. These cannot be switched off.
- Analytics — tell us which pages get read, so we know what is worth writing more of.
- Advertising — set by third parties such as ad and social platforms to measure and target campaigns.