Arizona state-regulated insurance coverage
Arizona requires meaningful coverage for autism under state-regulated plans. Arizona’s autism insurance bill, HB 2847, was enacted on March 21, 2008. The law became effective on June 30, 2009.
To which plan types does the STATE Arizona autism insurance law apply?
- State Employee Health Plans - YES
- Individual specifically exempt from the ACA (often called Grandfathered Plans) - NO
- Individual Plans subject to ACA - YES
- Fully Insured Large Group Plans - YES
- Fully Insured Small Group Grandfathered - NO
- Fully Insured Small Group Non-Grandfathered Plans - YES
What services are covered by the law?
- Diagnosis
- Behavioral Therapy Services
Does Arizona have caps on ABA coverage?
Yes. Coverage for behavioral therapy (ABA) is limited to individuals with autism that are less than 17 years of age and is subject to the following annual dollar caps:
- Under the age of 9= $50,000/year
- Between the ages of 9 and 16 = $25,000/year
Whether or not these caps are included in a health insurance plan is specific to each type of plan, and such limitations are required to be disclosed in the plan document. Most often, there is a specific section of the plan that describes the plan’s autism/ABA benefit. A consumer can contact plan representatives to learn where to find autism-related information in the plan document.
- There are now laws that challenge the validity of the age and dollar cap limitations. These are known as “mental health parity” laws, and they generally apply to services used to treat autism.
- Mental health parity laws prevent group health plans [and health insurance issuers] that provide mental health or substance-use disorder (MH/SUD) benefits from imposing less favorable limitations on MH/SUD benefits than on medical/surgical benefits. This means that quantitative treatment limits like age and dollar caps are not permitted in most cases.
- Learn about the federal mental health parity law, The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
- To learn about state mental health parity laws, the nonprofit Kennedy Forum sponsors a web-based tool, Parity Track, that provides further details on individual state laws, regulations, pending bills and implementation. (Autism Speaks is not responsible for the contents or opinions contained on third-party websites.)
Other comments about the law
For purposes of this law, “behavioral therapy” is defined as “interactive therapies derived from evidence based research, including applied behavior analysis, which includes discrete trial training, pivotal response training, intensive intervention programs and early intensive behavioral intervention.”