Are Self-funded Employer Plans Required to Follow State Autism Mandates?
No, self-funded employer plans are generally not required to follow state autism mandates.
While state-level autism insurance mandates require many private health insurance plans to cover treatments like Applied Behavior Analysis (ABA) therapy, these laws do not apply to every type of policy. The distinction depends on how the plan is regulated:
- Self-Funded (ERISA) Plans: These plans, often provided by large employers, are regulated by federal law under the Employee Retirement Income Security Act of 1974 (ERISA). Because they are governed at the federal level, they are exempt from state-level insurance mandates.
- State-Regulated (Fully Insured) Plans: These are subject to state laws and must comply with any applicable state autism mandates.
Although self-funded plans are not legally obligated to follow state mandates, many employers still choose to offer autism benefits voluntarily. To determine your specific coverage, you should review your Summary of Benefits and Coverage (SBC) or contact your human resources department to ask if your plan is self-funded or fully insured.
It is important to note that even when a mandate or coverage exists, insurance coverage is subject to verification and is not guaranteed.
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