Autism Insurance: Frequently Asked Questions

Are copays to be the same for each visit or provision of services?
627.6686(5), F.S. The coverage required pursuant to subsection (3) may not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions that apply to physical illnesses that are generally covered under the health insurance plan, except as otherwise provided in subsection (4).
Are they to be the same as for other services under the health plan?
See above
What will happen for State of Florida employees under BCBS (Under HMO arrangements)?
Coming soon
What will happen for State of Florida employees under BCBS (Under PPO arrangements)?
They should be covered at plan renewal. 627.6686(3)(d), F.S. "Health insurance plan" means a group health insurance policy or group health benefit plan offered by an insurer which includes the state group insurance program provided under s. 110.123. The term does not include any health insurance plan offered in the individual market, any health insurance plan that is individually underwritten, or any health insurance plan provided to a small employer.
What about city and county governments? Are they covered?
Coverage would have to be provided if the city or county had 51 or more employees.
Is there a listing of the insurance companies or group numbers that come in under the provisions of this act? How can a family know if their current plan is covered?
The Office doesn’t have a list of specific plans. The law only applies to large group plans that are issued or renewed on or after 4/1/2009. The Office does have a list of carriers in the large group market, however, we do not know if all these companies are actively selling.
Who do parents contact if they feel their rights under the Gellar act are being violated?
DFS Consumer services 1-800-342-2762
What about kids with Healthy Kids and the other "uninsured" kid-coverage programs funded by the state or pay-in? Do these plans come in under the Geller Act?
No.
Are PPOs and HMOs covered under this legislation?
Yes, the law only applies to large group plans that are issued or renewed on or after 4/1/2009.
What about services for medical diagnostic and evaluative services? Will there be a set of procedures that count as evaluative services and perhaps another that count as therapeutic services? What is the range of services that will be covered?
Other than the mandated services in the law, it will depend on what is provided in the Insurance contract.
Can clinical psychologist’s services be covered if they are providing diagnostic services? Will the services be covered if parent of a comprehensive assessment being conducted by a physician?
If they provide covered services referenced in 627.6686(3), F.S. then yes.
Can any fees for social workers be covered if they are providing coordinating services?
That will depend on the terms of the insurance contract.
We have a board array of alternative medical treatments, are these going to be covered?
Can chelation therapy be covered? If provided by a physician would it be covered?
See above.
How do parents determine when and if their provider is obligated to provide services under the Geller Bill?
They must determine if they have a small or large group and when the plan renews. The law only applies to large group plans that are issued or renewed on or after 4/1/2009.

Thank you to Eric Lingswiler, Interim Director of the Life and Health Product Review at the Florida Office of Insurance Regulation for providing this information.

Eric D. Lingswiler
Interim Director
Life and Health Product Review
Florida Office of Insurance Regulation
850-413-5110
eric.lingswiler@floir.com