Guest guest Posted June 11, 2011 Report Share Posted June 11, 2011 I read the legislation and it did not mention anything about fully-funded, just group policies. I wonder if there is an attorney out there who could read through this mandate and fill us in on the specifics? It sounds like this federal mandate applies to all group policies, not just full-funded policies but I could be reading the legal jargon incorrectly. Autism insurance > > > > > > > > > > > > > > > > ; > > > > The HR person at your husband's job would know if it's a self insured plan. > > > > Jayne > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2011 Report Share Posted June 11, 2011 The term "full-funded" policies is new to me. The term I see used most often is "self-insured" This might make a difference when reading the law. ito To: sList Sent: Sat, June 11, 2011 11:43:12 AMSubject: Any Attornmeys out there? I read the legislation and it did not mention anything about fully-funded, just group policies. I wonder if there is an attorney out there who could read through this mandate and fill us in on the specifics? It sounds like this federal mandate applies to all group policies, not just full-funded policies but I could be reading the legal jargon incorrectly. Autism insurance> > > > > > > > > > > > > > > > ;> > > > The HR person at your husband's job would know if it's a self insured plan.> > > > Jayne> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2011 Report Share Posted June 12, 2011 The State of Florida's Autism Insurance Mandate specifies that in order to be covered under the FL mandate your insurance policy has to be a fully-funded, large group policy. Most large group policies are self-funded now so the majority of people in this state are not covered under the mandate. When I read the new Federal mandate yesterday I saw no mention of the words self-funded or fully-funded, only stipulation I saw was that it must be a group policy. This makes a huge difference in who is covered and who is not. I was hoping there was a parent on this list who is an attorney who could read the mandate to see if there was some language in it I missed that will make a difference as to who is covered or not. Autism insurance > > > > > > > > > > > > > > > > ; > > > > The HR person at your husband's job would know if it's a self insured plan. > > > > Jayne > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2011 Report Share Posted June 12, 2011 If it's a federal mandate now instead of state won't it no longer matter how the group is funded? I thought once it became a federal mandate all group insurance providers would have to now cover the behavior. Is this not so? ThanksSent from my Verizon Wireless BlackBerrySender: sList Date: Sat, 11 Jun 2011 19:14:59 -0700 (PDT)To: <sList >ReplyTo: sList Subject: Re: Any Attornmeys out there? The term "full-funded" policies is new to me. The term I see used most often is "self-insured" This might make a difference when reading the law. itoTo: sList Sent: Sat, June 11, 2011 11:43:12 AMSubject: Any Attornmeys out there? I read the legislation and it did not mention anything about fully-funded, just group policies. I wonder if there is an attorney out there who could read through this mandate and fill us in on the specifics? It sounds like this federal mandate applies to all group policies, not just full-funded policies but I could be reading the legal jargon incorrectly. Autism insurance> > > >> > > > > > > > > > > > ;> > > > The HR person at your husband's job would know if it's a self insured plan.> > > > Jayne> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2011 Report Share Posted June 12, 2011 I am trying to figure that one out as well. I have been doing some reading on this on the Autism Speaks web site and according to this unless it is a fully-funded large group policy then insurance companies can opt out of the Autism coverage which means we are right back where we started. Here is what the wbsite states: "POTENTIAL COMMUNITY ISSUE 2: The insurance provision of the ATAA does not extend coverage to federal government civilian employees. AUTISM SPEAKS RESPONSE: According to a Congressional Research Service Report on the Health Insurance Portability and Accountability Act (HIPAA) of 1996, while there are no specific references in HIPAA or the subsequent benefits mandates that apply the requirements specifically to FEHBP, the plans provided by the FEHBP program are presumed to fall under the HIPAA definition of “group health plan.†As a result, the federal Office of Personnel Management, which administers the FEHBP program, complies with the HIPAA requirements. Therefore, if enacted, the ATAA would likely apply to federal government civilian employees. POTENTIAL COMMUNITY ISSUE 3: The insurance provision of the ATAA does not extend coverage to non-federal government employees (e.g. state government employees, local government employees, school district employees, tribal). AUTISM SPEAKS RESPONSE: State, local and tribal government health plans would be covered by the ATAA. However, a state, local, or tribal government employer that provided its employees with self-funded health plan coverage -- coverage under which claims are paid with the employer's own funds -- would be able to opt out of the ATAA's requirements, just as self-funded state, local and tribal government health plans can currently opt out of mental health parity and other federal insurance mandates. Roughly two-thirds of employees of state, local, and tribal governments are enrolled in self-funded health insurance plans. Many of these employees are in states that have passed autism insurance legislation, which may make opt-outs less likely." http://www.autismvotes.org/atf/cf/%7B2A179B73-96E2-44C3-8816-1B1C0BE5334B%7D/FACT%20SHEET%20-%20ATAA%20Insurance%20Provision.pdf Autism insurance > > > > > > > > > > > > > > > > ; > > > > The HR person at your husband's job would know if it's a self insured plan. > > > > Jayne > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2011 Report Share Posted June 12, 2011 , I think the link I gave for the " Federal autism insurance mandate " is actually a draft and hasn't gone into effect yet. I had thought that that was the mandate for my insurance change. I looked it up on the " autism votes " site which is usually very up to date on federal and state autism legislation, and it says that specific bill is still in the draft stage. I'm not sure which specific federal mandate is changing my plan to unlimited, but from what I researched, it looks like it falls under the Mental Health Parity law, which is a general federal mandate for mental health coverage that went into affect in 2010, and apparently autism is included. I will try to get a hold of our insurance Care Coordinator this week and see which federal law exactly it is that is getting us benefits. If it is the mental health parity, then self-funded would be included. The only restriction I saw on the mandate was 50 or more employees. No cap or limit on ABA from what I gathered. But still there could be loopholes we don't know about, like the insurance company saying ABA is not " medically necessary " etc.. HTH, Shiri > > > > > > I just found out that is is self-funded but it does cover ABA therapy but finding a participating provider is a different story. I wonder if there is a list of companies in FL who have fully-funded insurance? Thanks Jayne! > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Autism insurance > > > > > > > > > > > > > > > > > > > > > > > > ; > > > > > > The HR person at your husband's job would know if it's a self insured plan. > > > > > > Jayne > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2011 Report Share Posted June 12, 2011 I'm not sure exactly what you mean by a federal mandate. For example, it could be considered a federal mandate to eliminate unemployment. Any changes to the "self-insured" issue will have to address the present ERISA law which is the culprit. Subject: Re: Any Attornmeys out there?To: sList Date: Sunday, June 12, 2011, 3:05 PM If it's a federal mandate now instead of state won't it no longer matter how the group is funded? I thought once it became a federal mandate all group insurance providers would have to now cover the behavior. Is this not so? Thanks Sent from my Verizon Wireless BlackBerry Sender: sList Date: Sat, 11 Jun 2011 19:14:59 -0700 (PDT) To: <sList > ReplyTo: sList Subject: Re: Any Attornmeys out there? The term "full-funded" policies is new to me. The term I see used most often is "self-insured" This might make a difference when reading the law. ito To: sList Sent: Sat, June 11, 2011 11:43:12 AMSubject: Any Attornmeys out there? I read the legislation and it did not mention anything about fully-funded, just group policies. I wonder if there is an attorney out there who could read through this mandate and fill us in on the specifics? It sounds like this federal mandate applies to all group policies, not just full-funded policies but I could be reading the legal jargon incorrectly. Autism insurance> > > > > > > > > > > > > > > > ;> > > > The HR person at your husband's job would know if it's a self insured plan.> > > > Jayne> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2011 Report Share Posted June 12, 2011 Thanks for looking into this for us Shiri. We are changing to a self-funded large group policy that luckily has decided to cover Autism related therapies (specifically ABA), bu8t because they are not mandated to do so they could opt out of this coverage at any time. I want to be ready should this happen. I will do a little research into this Mental Health Parity law of which you spoke and see if I can figure it out. Thanks again for your time. Regards, Autism insurance > > > > > > > > > > > > > > > > > > > > > > > > ; > > > > > > The HR person at your husband's job would know if it's a self insured plan. > > > > > > Jayne > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2011 Report Share Posted June 14, 2011 Hello All,I deal with insurance companies daily and from what has been understood by everyone on my staff is that in order to be considered part of that federal mandate as a large group policy, a company must contain 50 employees or more to qualify for autism benefits. Its usually a 50% chance that a company covers autism benefits and if anyone on this listserv needs funding for autism treatment such as ABA because their insurance doesn't cover it, please message me because I am affiliated with many organizations that may help you with the cost.-AdamSent from my iPhone Thanks for looking into this for us Shiri. We are changing to a self-funded large group policy that luckily has decided to cover Autism related therapies (specifically ABA), bu8t because they are not mandated to do so they could opt out of this coverage at any time. I want to be ready should this happen. I will do a little research into this Mental Health Parity law of which you spoke and see if I can figure it out. Thanks again for your time. Regards, Autism insurance > > > > > > > > > > > > > > > > > > > > > > > > ; > > > > > > The HR person at your husband's job would know if it's a self insured plan. > > > > > > Jayne > > > > > > Quote Link to comment Share on other sites More sharing options...
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