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Health Insurance

BISMARCK, N.D. – Insurance Commissioner Jon Godfread today issued a Bulletin to all North Dakota health insurance carriers providing coverage for Autism Spectrum Disorder notifying them that treatments for autism cannot be excluded from an insurance policy.

“With this Bulletin, children diagnosed with autism in North Dakota will now have greater access to quality treatment for their condition,” Godfread said. “I am pleased to issue this Bulletin today and I hope that it will provide families across North Dakota with new access to quality treatment for autism through their insurance plans.” 

The Mental Health Parity and Addiction Equity Act states that insurance companies cannot make it more difficult to receive mental health or substance abuse treatment than it is to receive medical care. The law also says financial requirements, such as deductibles and co-pays, and treatment limitations, such as the number of visits or days of coverage, cannot be more stringent for mental health and substance abuse treatments than they are for medical care.  

If an insurance carrier chooses to cover autism and seeks to place limitations on autism treatments or benefits, it must demonstrate that a similar limitation exists with the medical portion of their insurance coverage.

In addition, Godfread notified insurance carriers in the Bulletin that they will no longer be allowed to exclude Applied Behavior Analysis (ABA) therapy to treat children with autism on the basis that ABA therapy is experimental or investigative treatment.

“Working with our partners at the federal level and with health insurers operating in North Dakota, we can now say that ABA therapies are no longer experimental or investigational and are widely recognized as a leading treatment for children with autism. Therefore, North Dakota families should have access to ABA therapies through their insurance plan” Godfread said.  

All grandfathered and transitional health insurance policies regulated by the Department, including the individual, small group, and large group insured markets, must follow the guidance set forth by the Bulletin beginning no later than Oct. 1, 2018. All non-grandfathered health insurance policies and self-funded Multiple Employer Welfare Arrangement health benefit plans regulated by the Department must follow the guidance of the Bulletin beginning no later than Jan. 1, 2019.

See Bulletin 2018-1 in its entirety for more information.

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