The New Jersey autism insurance mandate, in plain English.
New Jersey has a law that requires many health plans to cover autism treatment, including ABA. Here is what that means for your family, in plain terms.
This is general information, not legal or insurance advice. Every plan is different. Your plan documents and your insurer have the final word on coverage.
What the mandate is
In 2009, New Jersey passed a law requiring many state-regulated health plans to cover the diagnosis and treatment of autism. That includes behavioral treatment based on applied behavior analysis, or ABA.
Which plans it applies to
The mandate applies to plans regulated by the State of New Jersey. Many large employers use self-funded plans instead. Those are governed by federal law, so the state mandate may not apply. Some self-funded plans cover ABA anyway.
Not sure which kind you have? Ask your HR department or call the number on your insurance card.
What "covered" usually still involves
- A documented autism diagnosis
- Authorization before an assessment and before treatment
- Cost sharing, like copays, coinsurance, or deductibles
- Periodic reviews of progress to continue care
The carriers we are in network with
Centered Solutions is in network with Aetna, Blue Cross Blue Shield, and UnitedHealthcare. Being in network does not guarantee your specific plan covers ABA. We verify eligibility before anything begins.
Questions to ask your insurer
- Is my plan fully insured or self-funded?
- Does my plan cover ABA therapy for autism?
- Is authorization required, and for what?
- What will my cost sharing be?