Insurance Mandates – Indiana

In July 2001, House Enrollment Act 1122 went into effect as Indiana Code 27-8-14.2, mandating insurance coverage for individuals with Autism Spectrum Disorders for any accident or health insurance policy that is issued on a group basis (large or small). Also, insurers selling individual policies must offer the option to include coverage for Autism Spectrum Disorders (ASD).

If you have questions on the nature of your coverage, feel free to contact us for a free insurance benefits screening.

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Is my Insurance Covered by the Indiana Autism Insurance Mandate?

The Indiana Autism Insurance Mandate covers any health or accident insurance policy that is issued on a group basis (small or large). Insurers selling individual policies must offer the individual the option to include coverage for ASDs, probably at additional premium costs. Odds are, if you receive insurance through an employer that is based in Indiana, your policy is probably covered under the mandate. It is important to check with your Human Resources Department or Benefits Manager to determine if your plan is covered under the mandate.

A large exception to the law is “self-insured” companies. Self-insured companies are usually large companies that have several hundred employees. Instead of contracting with an insurance company to provide health insurance, the employer essentially is the insurer and supplies its own health plan to its employees. This may be confusing, however, as many self-insured companies use an existing insurance company to “administer” its health plan. That is, the insurance company only provides many of the “paperwork” functions of the health plan, such as claims processing or producing and distributing materials for the employees. To find out if your health plan is “self-insured”, ask a Human Resources representative at your employer. If you are under a self-insured plan, your employer is not obligated to provide any insurance coverage for ASDs. They may be willing to do so, though, if several employees express the need, or as a means of working in “good faith” to provide important benefits to valued employees. Self-insured companies may also offer health plan options to employees that fall outside of the self-insured plan. These may be covered under the mandate.

Another exception to the law involves an employer that is not based in Indiana, but has employees in Indiana. For example, you work for X Co.’s Indianapolis office, but X Co.’s headquarters are in Kansas. X Co. has contracted for health insurance for all of its employees nationwide with Insurer Y. This contract was done under a master policy in Kansas – thus Kansas law, not Indiana law, regulates it, and you would not be able to get coverage for ASD if Kansas law does not mandate it. If you work for ZZ Inc., which is a national company, but it has its “corporate home” in Indiana, the health plan contract done under Indiana law would require that ZZ Inc.’s health plan offer coverage for ASDs to all of its employees, whether they worked in Indiana or in another state. Therefore, if you work for ZZ Inc., an Indiana-based national company, but transfer to another state, the coverage for ASDs would still have to follow Indiana’s mandate because the insurance contract is under Indiana state law.

To find out if your plan is covered by the mandate:

  1. Determine if you are under a “self-insured” plan.
  2. Determine if your health plan contract was issued under Indiana state law, if it is, and it is a group plan, you should be covered.
  3. If your health plan was issued in another state, call that state’s Department of Insurance Healthcare Commissioner’s office and ask if that state has an insurance mandate for autism (a handful of other states do!).
  4. If you purchase an individual plan for yourself and your dependents in the state of Indiana, ask for a “rider” for coverage for ASDs (this will most likely raise your premiums).

Self-Funded Plans

Self-funded insurance plans are one of the most widely used forms of insurance coverage offered by employers. Because such plans are covered under federal law, they are exempt from state autism insurance laws. As many opt not to cover ABA, Autism Speaks has created this tool kit to help families find the coverage they need.