ABA In Plans

Self-Insured ERISA Large Employer-Sponsored Plans Resources

  • These plans are not impacted by a mandate or directive. However, many of these employers are adding ABA as a covered benefit.
  • These plans need to be in compliance with the Federal Mental Health Parity Law (learn more on Autism & Law tab).
  • What can you do if no coverage:
  • If you cannot get answers or are being denied services you can also reach out to the regulating body:

Fully Funded Employer-Sponsored Group and Individual, Child Only and Family Private Market Broker Plans

Child-Only Health Plans through ACA Exchange Marketplace

  • ACA Exchange child-only plans and qualifying for subsidies
    • If your child has access to an employer-sponsored plan, you will not be eligible for a discounted (subsidy) Marketplace plan.
    • You can still purchase a non-discounted child-only Marketplace plan. Some plans allow you to carry more than one policy while others do not.
    • What are Essential Health Benefits?
    • A child-only policy may be a good option if:
      • the child lives with grandparents who do not have private insurance because they are eligible for Medicare, and the child is not eligible for Medicaid or the Children’s Health Insurance Program.
      • Parents who are divorced or live in different states.
      • Families affected by autism whose job-based coverage does not include ABA.
      • Individuals with autism who do not qualify for Medicaid
    • What health insurance providers are selling plans on the exchange in Ohio 2020?
      • AultCare Insurance Company
      • Buckeye Community Health Plan
      • CareSource
      • Community Insurance Company
      • Medical Health Insuring Corp. of Ohio
      • Molina Healthcare of Ohio, Inc.
      • Oscar Buckeye State Insurance Corporation
      • Oscar Insurance Corporation of Ohio
      • Paramount Insurance Company
      • Summa Insurance Company

Ohio Dept of Insurance FAQ & Rates for ACA Exchange Plans

In 2019, the weighted average premium for an on-exchange individual market plan was $6,161.56 and for 2020 the weighted average premium based on approved products is $5,690.26 – a decrease of 7.7 percent.

2020 monthly premium is $474 minus any qualifications for premium tax credit and CSRs or cost sharing reduction.

The 4 Medal Plans:  https://www.healthcare.gov/choose-a-plan/plans-categories/
Plan Category          The insurance company pays              You pay
Bronze                                     | 60%                                                 | 40%
Silver                                         | 70%                                                 | 30%
Gold                                           | 80%                                                 | 20%
Platinum                                 | 90%                                                 | 10%

Need a Broker to learn more about Child Only & Family Plans?

The Coalition has teamed up with Halle Morgan with Morgan Benefits, LTD to help parents find the right non-employer health plan for them. Please feel free to reach out to her at 216.230.6391 or halle@morganbenefits.com


Medicaid in Schools Program (MSY)

Medical Necessity – Elements

ABA Treatment and Clinical Structure

Ohio’s Autism Directive & Autism Mandate

Ohio Department of Insurance

Speech & Occupational Therapy