Virginia State-Regulated Insurance Coverage
Virginia requires meaningful coverage for autism under state-regulated plans.
Virginia’s autism insurance bill, HB 2467, was enacted in 2011 and became effective on January 1, 2012. It was expanded in March 2019 by HB 2577 which eliminated the previous age cap, and in March 2020, SB 1031 expanded coverage to small group and individual plans.
To which plan types does the state autism insurance law apply?
- Individual Plans - YES
- Fully Insured Large Group Plans - YES
- Fully Insured Small Group Plans - YES
What services are covered by law?
- Diagnosis
- Behavioral Health Treatment
- Pharmacy Care
- Psychiatric Care
- Psychological Care
- Therapeutic Care (e.g. services provided by licensed or certified speech language pathologists, occupational therapists, physical therapists or social workers)
- Applied Behavior Analysis (ABA)
Does Virginia have caps on coverage?
Yes. Coverage for ABA is subject to a maximum annual benefit of $35,000.
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. This includes quantitative treatment limits like age and dollar caps.
Where can I find more details about the Virginia autism insurance law?
A copy of HB 2467 as enrolled can be found here. A copy of HB 2577 can be found here. A copy of SB 1031 can be found here.
Recent Announcements
November 2021 - Anthem recently reversed its exclusion of applied behavior analysis in its 2021 HealthKeepers plans, after the Virginia Bureau of Insurance identified the exclusion as a violation of the Mental Health Parity and Addiction Equity Act (MHPAEA). Families who purchased these plans on the individual marketplace and have been denied ABA coverage should reach out to Anthem immediately.
If you have additional questions, please email advocacy@autismspeaks.org.
Last Updated: November 2021