As previous posts have noted, state insurance mandates do not apply to self-funded plans, which come under ERISA. The Harvard Crimson offers one example:
In 2010, Governor Deval L. Patrick ’78 signed House Bill 4935 (An Act Relative to Insurance Coverage for Autism Spectrum Disorder), which required private health insurance plans to provide coverage of medically necessary autism therapies. The bill went into effect on January 1, 2011. Before this bill, the lack of coverage for autism therapies had been an enormous financial burden for families. More importantly, it meant that each individual that went untreated was losing precious time in which to make developmental gains. Denial of coverage has long been recognized as discriminatory to the special needs population and their families.32 states have enacted such legislation to combat insurance discrimination and meet the urgent needs of individuals and families profoundly affected by the challenges of living with autism.
However, at Harvard, the financial burden continues, along with parental grief that ones’ child is not getting the critical therapies needed to make progress in all areas of development. Due to an exemption in the state law, the families of Harvard employees continue to be excluded from coverage for much needed autism therapies. Under the Massachusetts law, self-funded plans, like Harvard's, are not required to provide medical coverage for autism treatments. Harvard employees and their families remain without access to the unlimited and intensive therapeutic and rehabilitative care (particularly Applied Behavioral Analysis) which has been deemed necessary by Harvard's very own medical researchers. Such services include training for parents and primary caregivers in order to help them manage their children's self-care skills, behavior, social skills, and communication. ABA is the most commonly prescribed therapy for individuals with autism, and, in addition to being endorsed by the medical community, it isrecognized as the most effective treatment by the Surgeon General, the National Research Council, and the American Academy of Pediatrics.
