How do I know if my policy has autism coverage?

Who is this for?

Michigan Health Insurance – Customer Service – Learn More

If you’re a Blue Cross Blue Shield of Michigan or Blue Care Network member, this information will help you find out if your plan covers the diagnosis and treatment of autism spectrum disorders.

Last year, Michigan passed a law that required some health plans to cover the diagnosis and treatment of autism spectrum disorders, including:

  • Autistic disorder
  • Asperger’s disorder
  • Pervasive developmental disorder not otherwise specified

Do I have autism coverage?

The law that was passed applies to two kinds of health plans:

  • Individual health care plans (you buy your own health insurance)
  • Fully-insured group plans

These plans all have standard autism benefits.

Why do some plans have coverage and others don't?

Not all health insurance plans are required to have autism coverage, such as:

  • Federal health insurance programs like Medicare
  • Self-insured group health care plans

Self-insured group plans can have autism coverage. But it's not required, and the coverage can be different from standard benefits.

What’s the difference between fully-insured and self-insured health care plans?

With a fully-insured health care plan, an employer buys health insurance from an insurance company. With a self-insured health care plan, an employer provides health care benefits directly to employees. The money that the employer would have paid to a health insurance company as a premium goes toward paying the doctors for their services. The health insurance company just helps the employer administer the plan.

How do I find out what kind of plan I have?

If you have group health insurance, you can ask your HR representative. Or you can call the number on the back of your enrollee ID card and we'll help.