by Maryanne Nugent, Director of Marketing and Family Support
Families of children with Autism have many day-to-day concerns. However, most people don’t realize that obtaining insurance coverage for medically necessary therapies is one of the biggest.
Fortunately in 2008 the Illinois Autism Act was passed, which guaranteed coverage for families who had a “fully insured” insurance policy, such as an individually purchased policy or a small employer group policy. These families were free to access Applied Behavior Analysis (ABA) therapy, which is the most frequently prescribed treatment for Autism. However, the majority of families (approximately 70% of the insured in Illinois) that have a work-related, self-funded policy, were left out of this mandate and found themselves without coverage for ABA.
Recently, a few of the large employer-based health plans that are self-funded have elected to cover ABA therapy. Unfortunately, less than 30% of all self-funded company plans in Illinois have chosen to do so. Employees who would like to approach their employer about covering ABA therapy can receive assistance from Autism Speaks.
Thanks to the Affordable Care Act, the situation has drastically improved. The ACA has made buying individual policies extremely affordable and easy. It also allows families who have a “self-funded” plan from their large employer that excludes ABA therapy to pull their child off of the corporate policy and buy an individual policy. This does not jeopardize the corporate insurance benefits for the rest of the family.
Bill Luvisi of Senior Consultants, Inc. has written dozens of ACA policies for families of children with autism: “Obtaining proper guidance is essential to obtaining an individual plan that covers ABA. Only a broker that has worked extensively with families that have children on the Spectrum should be consulting these families. I have found the policies we have placed with families to be a financial and emotional lifesaver. Families have been able to obtain critical ABA therapy for their child, while at the same time avoiding what would have been a financial disaster by having to pay for the much needed service themselves.
“The government has ordered one more special enrollment period between March 15th and April 30th for certain qualifying events. Since the ACA has uniform pricing on these policies, our office offers free, no-extra-charge guidance to this special enrollment period. Contact us for the proper plan using any of the following methods:
firstname.lastname@example.org: 847-362-8000, Ext 101.”