What is the Difference between a State Mandate and an Erisa Plan for Aba Therapy?
The difference between a state mandate and an ERISA plan primarily involves which laws regulate the insurance coverage and whether the insurer is legally required to provide autism-related benefits.
State Mandates
An autism insurance mandate is a state-level law that requires certain health insurance plans to cover the diagnosis and treatment of autism, including ABA therapy. These mandates apply to state-regulated (fully insured) plans. However, these laws are not universal and vary by state regarding age limits and coverage caps. For example, Arizona’s mandate covers ABA up to age 16, while Utah’s mandate is more limited, covering it only up to age 9.
ERISA Plans
ERISA plans (Employee Retirement Income Security Act of 1974) are typically self-funded or self-insured plans provided by large employers. These plans are regulated by federal law rather than state law. Because of this, they are generally exempt from state insurance mandates. Key points include:
- Voluntary Coverage: A self-funded plan is not legally obligated to follow a state’s autism mandate.
- Employer Choice: While not required, many employers with ERISA plans still choose to offer ABA therapy benefits voluntarily.
- Plan Documents: For ERISA plans, the specific insurance coverage is defined by the employer’s plan document rather than state legislation.
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