Relating to insurance coverage for covered individuals for the treatment of autism spectrum disorder and including applicability provisions

This bill relates to insurance coverage for covered individuals for the treatment of autism spectrum disorder (autism). The bill changes the definition of autism under current law to align with the American psychiatric association’s diagnostic and statistical manual of mental disorders. Under current law, a group plan established pursuant to Code chapter 509A for employees of the state that provides for third-party payment or prepayment of health, medical, and surgical coverage benefits (coverage) shall provide coverage to covered individuals under years of age for the diagnostic assessment and treatment of autism, and coverage is required in a maximum benefit amount of not more than $36,000 per year. The bill eliminates the 21-year maximum age limit and the maximum benefit amount. Under current law, a group policy, contract, or plan (policy) providing for third-party payment or prepayment of health, medical, and surgical coverage shall provide coverage for applied behavior analysis (analysis) provided by a practitioner to covered individuals under years of age for the treatment of autism pursuant to a treatment plan if the policy is either a policy issued by a carrier to an employer who on at least percent of the employer’s working days during the preceding calendar year employed more than full-time equivalent employees, or the policy is established pursuant to Code chapter 509A for public employees other than employees of the state. Under the bill, the age restriction is eliminated. Current law requires that the coverage for analysis shall provide an annual maximum benefit of not less than $36,000 for individuals through age six, $25,000 for individuals age through 13, and $12,500 for individuals age through 18. The bill eliminates the maximum benefit amounts and the age categories.28. The bill applies to plans specified in the bill that are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2026.