On Feb. 2, 2015, the Virginia Bureau of Insurance published Administrative Letter 2015-01, which relates to coverage for autism spectrum disorder in the small group market. In 2011, Virginia enacted a law that requires coverage for the diagnosis and treatment of autism spectrum disorder in children from age 2 through age 6, including the treatment known as applied behavior analysis. However, small group plans are exempt from that coverage requirement.
Currently, 'small group' coverage is defined as coverage for employers with 50 or fewer employees. However, beginning in 2016 the definition of 'small employer' increases to 99 or fewer employees. Further complicating the matter, Virginia also has a law that requires any product approved for sale in the small group market to be guaranteed as available to all small employers. So, while the plan language of the Virginia autism mandate applies only to health plans sold to employers with more than 50 employees, the Virginia guaranteed availability requirements require that any plan approved for sale must be offered to all small employers.
The bulletin addresses that conflict by stating that unless Virginia passes a law requiring otherwise, insurance carriers are expected to provide autism spectrum disorder coverage to all employers in the small group market (i.e., 1-99 employees) for plans beginning on or after Jan. 1, 2016. The bulletin does not change or otherwise affect Virginia employers' compliance obligations, but does serve as a helpful resource for small employers on autism spectrum disorder coverage through their plans.
Administrative Letter 2015-01 »