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Self-funded vs Fully insured Autism Coverage

As a mom of a child affected by autism, I obligate myself in discovering as many resources, therapy options and educational stimulants possible in an incessant effort to assist my son with overcoming his challenges. As the nation’s 4th most state affected by autism, the passing of the latest autism insurance reform bills 414, 415 and 981 is definitely a buzz word around Michigan these days. With all of its accolades and promising factors, whether or not this new legislation benefits YOU will depend on what type of insurance coverage you have – self-funded verses fully insured. To put it in perspective, when you buy your own insurance on the open market, in effect, you are paying someone else (an insurance company) to take on the risk that they will pay out more in benefits than they collect from you in premiums. This is known as being “fully-insured” or “fully-funded.” Alternatively, if you decide to assume the risk yourself – i.e., to save your premium dollars and use them to pay your health care bills on your own – you are considered “self-insured” or “self-funded.” –more flexibility, more control. There are a lot of large companies that provide benefits through self-funded health care policies, i.e. Consumers Energy, Ford, General Motors, DTE, Home Depot and Meijers, just to name a few. Unfortunately, state insurance regulations like 414 & 415 “do not apply to self-funded employer insurance plans.” These plans are overseen by the federal government. Those employers can choose to cover autism as part of their benefits on their own, but they’re not compelled to do so by this new legislation. Summarily, this still leaves a lot of families in the same boat as before the new legislation. The tertiary element of this set of bills, 981, offers a glimmer of hope as an incentive program created to encourage self-funded employers to adopt autism coverage for kids on the spectrum. Here lies the trick, don’t take for granted that your employer is aware of the logistics of this new set of bills. Visit your employer’s claims department and state your case. Arm yourself with explanation of benefits of coverage from your standpoint and theirs. Coverage benefits are set to be in place around October, and in the interim the Autism Alliance of Michigan (AAoM), Michigan Lt. Governor Brian Calley, and Behavior Analysis Assoc. of Michigan (BAAM) is hosting a series of FREE informational Parent and Employer workshops & webinars covering a wide array of subjects including “Understanding the benefit, process, and option for state paid claims; Self-adopting autism insurance benefit for self-funded companies in Michigan; Why covering autism is good policy; and Benefits to ERISA companies of self-adoption.” To register or for more information, visit http://aaomemployersworkshop.eventbrite.com/

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