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Michigan Insurance Requirements for Autism Spectrum Disorder

The information below is collected from state statutes and regulations. The information is reviewed on an annual basis. Please be advised that laws, regulations, and policies may change at any time, so always check with your state for the most up-to-date information.

Note: Certain insurance plans are exempt from state mandates. Please contact your plan administrator to see if your plan includes state mandated autism spectrum disorder benefits.

Specific Insurance Mandate

The state of Michigan has a specific autism mandate, which requires certain insurers to provide coverage for autism spectrum disorder.

Effective January 1, 2014, requires a health care corporation group or non-group certificate to provide coverage for the diagnosis of autism spectrum disorders and treatment of autism spectrum disorders.

Treatment of autism spectrum disorders prescribed or ordered for an individual diagnosed with one of the autism spectrum disorders by a licensed physician or a licensed psychologist includes:

  • Behavioral health treatment
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care (including services provided by a licensed or certified speech therapist, occupational therapist, physical therapist, or social worker)

Coverage for treatment of autism spectrum disorders may be limited to a member through 18 years of age and may be subject to a maximum annual benefit as follows:

  • For a covered member through 6 years of age, $50,000.00;
  • For a covered member from 7 years of age through 12 years of age, $40,000.00;
  • For a covered member from 13 years of age through 18 years of age, $30,000.00.

Resources

For further information on insurance mandates for autism spectrum disorder, please visit these websites: 

Mich. Comp. Laws §550.1461(e) as added by:

Questions regarding state affairs issues? Call ASHA at 800-498-2071 and ask for the State Affairs Team.

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