Senate Approves Autism Insurance Coverage Legislation


Senate Approves Autism Insurance Coverage Legislation

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Senate Approves Autism Insurance Coverage Legislation

Senate Bill 397 passed the Georgia State Senate on Tuesday by a vote of 51-0.   If adopted, this legislation will require insurers to provide coverage for children up to six years old who are diagnosed with an autism spectrum disorder.

“Each year the Senate focuses on hundreds of bills throughout the legislative session, but voting yes to Senate Bill 397 is a day for the history books,” said Sen. Dugan.  “Autism effects one in 84 children and one in 54 boys across Georgia. Although we cannot prevent autism we can enact legislation that lowers the financial burden for parents and provides additional resources for children with autism.”

Senate Bill 397 would require health care policies to include:

  • ·         Coverage for any assessments, evaluations, or tests prescribed by a physician or psychologist to diagnose Autism Spectrum Disorder
  • ·         Autism Spectrum Disorder treatment if deemed medically necessary
  • ·         Unlimited doctor or specialized care visits
  • ·         Up to $35,000 annually in coverage for applied behavioral analysis (ABA) treatments
  • ·         Prescription drug coverage if it is already provided by the policy or contract

Insurers who prove coverage would result in at least a one percent rate hike for all policies, or the costs associated with treatment would exceed one percent of the premiums charged over the experience period, would be exempt from providing coverage for one year.

The coverage requirements outlined Senate Bill 397 does not apply to plans for small businesses with less than 10 employees. Additionally, there is no requirement to provide coverage for autism spectrum disorder for any insurance plans offered through the health exchange.

If signed into law, Georgia would join 35 other states that currently provide some form of autism insurance coverage.

Senate Bill 397 now transfers to the House of Representatives for consideration.

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