West Virginia State-Regulated Insurance Coverage
West Virginia requires meaningful coverage for autism under state-regulated plans.
West Virginia’s autism insurance bill, HB 2693, was enacted in 2011 and became effective on January 1, 2012. HB 4260 was enacted in March 2012 to correct technical errors in the 2011 law. It specifically clarified that a $30,000 annual cap on benefits applies only to ABA, not on all benefits.
To which plan types does the STATE autism insurance law apply?
- Individual Grandfathered Plans - NO
- Individual Non-Grandfathered Plans - YES
- Fully Insured Large Group Plans - YES
- Fully Insured Small Group Plans - YES
What services are covered by law?
- Diagnosis
- Applied Behavior Analysis
- Treatments that are medically necessary and ordered or prescribed by a licensed physician or licensed psychologist and in accordance with a treatment plan
Does West Virginia have caps on coverage?
Yes. Coverage is limited to individuals with autism ages 18 months to 18 years. To be eligible for coverage the individual must be diagnosed with autism spectrum disorder at age eight or younger.
Coverage for ABA is also subject to a maximum annual benefit of $30,000 for 3 consecutive years. At the conclusion of the third year, coverage for ABA is subject to a maximum monthly benefit of $2,000.
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 West Virginia autism insurance law?
A copy of HB 2693 (2011) as enrolled can be found here.
A copy of HB 4260 (2012) as enrolled can be found here.
If you have additional questions, please email advocacy@autismspeaks.org.
Last Updated: December 2019