frequently asked questions about the texas autism insurance law
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1. Texas Autism Insurance Law History
HB 1919 was enacted June 15, 2007. HB 451 was enacted June 19, 2009. SB 1484 was enacted June 14, 2013.
2. To which plan types does the Texas autism insurance law apply and what is the effective date of coverage?
Plan Type Subject to Terms of Bill? Effective Date Comments
State Employee Health PlansIndividual PlansFully insured large group plansFully insured small group plans
Some Jan 1, 2010 see #6 belowNo NAYes Jan 1, 2008Yes Jan 1, 2008
3. Which autism services are required to be covered by the law?
• Evaluation and assessment services• Applied behavior analysis (ABA)• Behavior training and behavior management• Speech therapy, occupational therapy and physical therapy• Medications or nutritional supplements
4. Does the law impose age limits or annual dollar caps on coverage?
As of September 1, 2013 there is no age limit on coverage for the treatment of autism. However, in order to be eligible for coverage the individual must have been diagnosed with autism prior to age 10. There is no limit on benefits for individuals under 10 years of age. Coverage for ABA is subject to a maximum annual benefit of $36,000 for individuals age 10 or older.
5. Where can I find more details about the Texas autism insurance law?
Please see the following links for HB 1919, HB 451 and SB 1484 as enrolled.
6. Other comments about the law.The 2009 law raised the age cap to age 10 and added coverage for public school employees. The 2013 law removed the age cap and imposed a maximum annual benefit on ABA for individuals age 10 or older.
If you have additional questions, please email [email protected].
Frequently Asked Questions about the Texas Autism Insurance Law