The Impact of the Disability Insurance Mandate on Self-Funded Insurance Plans
State insurance mandates like the therapy mandate only apply to some insurance plans. All fully-insured plans now must honor the therapy mandate for children with disabilities. In Missouri, 1/3 of insurance plans are fully-insured plans. The majority of self-funded plans do not have to honor the mandate. As disappointing as it is, there still is hope for those with self-funded plans.
What is a self-funded insurance plan?
"Many employers provide health insurance by “self-funding” their health plans. Self-funded health plans are arrangements where the employer pays health claims from their own funds, but often contract with a health insurance company or third party administrator to process claims. Such plans are governed under the federal Employee Retirement Income Security Act (ERISA), and states have little jurisdiction over private employers that choose to self-fund." (DIFP's 2019 Autism Report)
In Missouri, plans which are not self-funded should have "fully insured" written somewhere on the insurance card. Still, the best way to find out if your plan is self-funded is to check with your employer.
Will this legislation apply to any self-funded plans?
There are a few self-funded plans outlined in the legislation (Sections 376.1224.10 & 376.1224.11) which will have to follow this mandate and provide children with disabilities coverage for habilitative therapies. These include the Missouri consolidated health care plan and self-insured governmental plans.
What do I do if I have a self-funded plan which won't be covered?
Rest assured--you are in good company. About 2/3 of insurance plans in Missouri are self-funded. The majority of the families who worked to get this legislation passed are on self-funded plans. That doesn't negate the importance and benefit of this legislation. Many employers choose to follow state mandates. This legislation will be the platform which many people will use to convince their employers to expand their coverage.
We encourage those with a self-funded plan to sit down talk with your employer. The HR office is a great place to start. Set up an appointment to explain the importance of the new mandate and ask your employer to implement the mandate. Be positive and heartfelt as you explain why therapy coverage is so important for your family and the other employees at your place of employment.