Once you work through the steps below and know the type of health plan you are enrolled on, ask the employer or broker for the plan’s benefit manual. Look for Autism Spectrum Disorder or Applied Behavior Analysis and review the plan’s medical necessity definition and benefits for treatment. Also, find your type of health plan on the pie chart below and that will help you further see if you have benefits for treatment.
Step 1: How do I access my health plan?
I am employed by a company,
ask your employer’s benefits department or human resources which one of the three types of health plans below they offer their employees.
Fully-Insured Plans – If a Fully-Insured Health Plan is the type of health plan your employer provides, find out if the plan was authored before the ACA (access to autism mandate benefit) or after the ACA (essential health package benefit).
Self-Funded or ERISA Plans – These plans are not impacted by mandates or state legislation and each company chooses whether or not to provide an ABA benefit. Here is a list of Self-Insured employers covering ABA per State – see pages 6-9 Autism Speaks SELF Funded Tool Kit
ACA Exchange Marketplace Small Business Health Plans “Get Covered Illinois” – These employer health plans have access to autism treatment benefits.
I am a government employee or federal employee,
State, county and municipal employees have access to an autism benefit through their mental health plans called Healthlink or Magellan. Federal & Military employees have ABA benefits in their health plans as well.
I have purchased an Individual or Family Private Plan purchased through a Broker,
ask the broker when the plan was authored: Before the ACA (autism mandate) or after the ACA (essential health package benefit).
I have purchased an Individual or Family health plan on the ACA Exchange,
your plan was authored after the start of the ACA and has an autism benefit in the essential health package benefit.
I have a public health plan such as Medicaid,
access to autism treatments are fragmented and you do not have a benefit for ABA treatment. See our Public Policy Initiative page to learn more about this challenge. If you have a Child or Adult Waiver, you have access to Behavior Interventions through the 56U Program.
My child is between the ages of 0 and 2 years old
and is diagnosed or suspected to have an Autism Spectrum Disorder or developmental disability. You will want to look at your health plan for benefits and also reach out to Illinois’ Act Early Early Intervention Program.
Step 2: Find your type of health plan on our Autism Treatment Coverage Pie Chart and learn about treatment coverage.
Check out our webinar that will walk you through this chart.
Click on chart to enlarge.
Step 3: Learn about the Autism Benefits in Illinois
Autism Mandate Benefit in Statue 215: Illinois Autism Mandate Law and Benefit
ACA’s Essential Health Package Benefit for Autism in Illinois provides treatment with no funding caps for individuals ages birth through 20.
Federal Employee Health Plan Information
Check out our Webinar that walks through the above chart and describes the different types of insurance products and autism benefits. Link
Visual Organizational Chart – Illinois’ overall structure of support systems
Click on chart to enlarge