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Illinois 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 Illinois has a specific autism mandate, which requires certain insurers to provide coverage for autism spectrum disorder. 

The mandate requires certain health insurers to provide individuals under 21 years of age coverage for the diagnosis of autism spectrum disorders and for the treatment of autism spectrum disorders. Treatment includes the following care prescribed, provided, or ordered for an individual diagnosed with an autism spectrum disorder by (A) a physician licensed to practice medicine in all its branches, or (B) a certified, registered, or licensed health care professional with expertise in treating effects of autism spectrum disorders when the care is determined to be medically necessary and ordered by a physician licensed to practice medicine in all its branches; psychiatric care, meaning direct, consultative, or diagnostic services provided by a licensed psychiatrist; psychological care, meaning direct or consultative services provided by a licensed psychologist; habilitative or rehabilitative care, meaning professional, counseling, and guidance services and treatment programs, including applied behavior analysis, that are intended to develop, maintain, and restore the functioning of an individual; therapeutic care, including behavioral, speech, occupational, and physical therapies. Coverage provided shall be subject to a maximum benefit of $36,000 per year, but shall not be subject to any limits on the number of visits to a service provider.

Resources

For further information on insurance mandates for autism spectrum disorder, please visit this website: 

Ill. Comp. Stat. ch. 215, § 5/356z.14

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

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