SB224 Alabama 2016 Session

Summary

Primary Sponsor

Gerald H. AllenSenator

Republican

Session

Regular Session 2016

Title

Autism, health benefit plans, coverage of autism spectrum disorder under certain conditions, Secs. 10A-20-6.16, 27-21A-23, 27-54A-2 am'd.

Summary

SB224 would require certain health benefit plans to cover autism treatment for children nine and under, with specific limits and conditions.

What This Bill Does

It would require group health benefit plans issued to employers with 51 or more employees (for at least half of the previous year) to cover screening, diagnosis, and treatment of autism for children nine and under, as prescribed by a treating licensed physician or psychologist under a treatment plan. Coverage cannot be denied or terminated solely because of autism, and behavioral therapy is capped at $36,000 per year (adjusted annually by CPI), with coverage also including services like applied behavior analysis, psychiatric, psychological, and therapeutic care. The rules apply to policies delivered in Alabama, but self-funded plans administered by the same corporation are exempt, and the act takes effect October 1, 2016.

Who It Affects

• Children aged 9 years and under with Autism Spectrum Disorder and their families, who would gain coverage for screening, diagnosis, and treatment under eligible group health plans.
• Health benefit plans and insurers that issue group policies to large employers (51+ employees) in Alabama, who would be required to offer ASD coverage under the described conditions (including treatment plans, limits, and CPI-based maximums).

Key Provisions

• Requires health benefit plans to cover screening, diagnosis, and treatment of Autism Spectrum Disorder for insured children nine years old or younger in Alabama, for policies issued to employers with 51+ employees for at least 50% of the prior year.
• Coverage must be prescribed by the insured's treating licensed physician or licensed psychologist and must follow a formal treatment plan; updated treatment plans may be requested no more than every six months.
• Prohibits denial, non-renewal, or restriction of coverage solely because an individual has Autism Spectrum Disorder; coverage is subject to general plan exclusions and requirements.
• Behavioral therapy coverage is capped at $36,000 per year and adjusted annually by CPI; coverage includes behavioral health treatment, pharmacy, psychiatric, psychological, and therapeutic care when prescribed.
• Definitions and terms related to Autism Spectrum Disorder, Applied Behavior Analysis, and related treatment services are included to clarify what is covered.
• Effective date: October 1, 2016; self-funded plans administered by the insurer are exempt from these specific requirements.

AI-generated summary using openai/gpt-5-nano on Feb 24, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Health