The autism coverage mandate applies to:
- All small group or large group health insurance plans written in Missouri.
- All small group or large group health insurance plans written in other states but insuring Missouri residents, to the extent not already covered by the plan.
- All self-insured governmental plans (defined by USC Section 1002(32).
- All self-insured group arrangements, to the extent not pre-empted by federal law.
- All plans provided through a multiple employer welfare arrangements or other benefit arrangements, to the extent not pre-empted by federal law.
- All self-insured school district plans.
For the following types of insurance, the coverage is not automatically included, but must be offered to the insured and dependents:
- Individually underwritten health insurance plans.
- Individually underwritten association groups.
- Other individually underwritten discretionary groups.
The law does not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, short-term major medical policy of six months or less duration, or any other supplemental policy, even if such policies are offered on a group plan basis.
“Individually underwritten” health insurance is insurance coverage that is obtained outside of one’s employment. It means each person is charged a premium amount for coverage that reflects that person’s individual health status (health conditions, age, tobacco use, etc.).
In “self-insured” or “self-funded” plans, the employer pays medical claims directly, rather than purchasing a group insurance policy. In many cases, these employers will hire an insurance company to administer the plan and pay claims for them. However, ultimately, the employer decides on the coverage and pays the claims. Many of these self-insured plans are exempt from state insurance laws, including the new autism law.
