Monday, March 2, 2015

Self Funded Employers and Autism Insurance

I had considered myself fortunate when it came to health care for our son.  For  12 years we never had an issue and never had to fight for services.  We were always covered. Until.... my husband's employment changed, along with the health coverage,..and of course they are self-funded and not mandated to have autism coverage. How is that fair?

I have been getting yet another "forced" education in something I really never had an interest in.

IF your employer has a "self-funded insurance plans" or "cafeteria plan" they are NOT subject to the state laws and mandates.  They get to pick and choose the coverage they want.  Now this MAY change.  Somewhere in the near future ALL plans will be mandated.  When is the "near future though?"...

Shocked me to hear that some companies even still believe that Autism isn't a medical disorder and that behavior therapies should be the responsibility of the parents and the school!!

The current employer for has over 200k employees,  with the statistics in Autism it's hard to believe  that there isn't one other person affected by it in this company?

I have tried calling Human Resources (HR) Department to see if not having the Autism Insurance Benefit is an it was an oversight? It wasn't.... and asked if  they would be willing to make and "exception" for us put a rider on our policy.... They won't.

Here is some other information I have found online to help convince your company to think about adding this to their coverage...We didn't have luck. Hope you will...

Autism speaks has this great Self Funded employer tool kit to download featuring a presentation and sample letters.

Of course I have been working with our school as much as I can for access to a BCBA there are only so many hours they will allow but I will take anything.

 I have applied for state insurance (ours is masshealth) as a secondary and "only" with a $800 premium a month (on top of the primary insurance we have now)they will cover autism services.  ha!

Because of this problem with self funded companies, many children (as mine has) suffer greatly.

I  would love to hear of any experiences out there, anything from frustrations to success story's  and advice... comment below of email me at

1 comment:

  1. the autism insurance will come to solve our problems more so health care needs I have had challenges with my health care provider in the past but I hope this would solve the problem