Autism Insurance: Ava’s Law

Ava’s Law was signed by Governor Nathan Deal in April 2015. The law became effective July 1, 2015 upon insurance plan year renewal date. For many, this is January 1, 2016. In summary, the plan requires coverage for medically necessary treatment prescribed, provided or ordered to an individual diagnosed with an autism spectrum disorder by a licensed physician or licensed psychologist.

Treatments included in the law include the following:

  • Habilitative or rehabilitative services, including behavior analysis
  • Psychiatric, psychological and counseling services
  • Speech, occupational and physical therapy

There are a few additional details that you must also be aware of as it relates to Ava’s Law.

  • Coverage of Applied Behavior Analysis (ABA) is restricted to $30,000 annually for children ages six and under. For State of Georgia employees, the limit for ABA is slightly more and provides coverage for children ages ten and under. ABA is provided or supervised by a BCBA or BCABA certified by the Behavior Analyst Certification Board.
  • The law does not limit benefits that are otherwise available to an individual under the plan (i.e. speech, occupational or physical therapy).
  • The law does not affect any obligation to provide services to an individual under an individualized family service plan, an individualized education program, or an individualized service plan.
  • The law only affects State regulated health insurance plans. It does not impact Federally regulated plans (ERISA) which include self-funded plans. There are self-funded plans that do include coverage for autism. For example, Georgia Pacific and AT&T have included coverage.

The most important steps you can take are to understand whether your plan is State or Federally regulated (includes self-funded) and whether your plan options included coverage for an autism spectrum disorder. This is simply accomplished by speaking with your company’s Human Resources Department.

Please contact us toll free at 1-844-404-ASGa (2742) if you have questions or coverage has been denied.