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Autism Insurance Coverage North Carolina

  • Publish Date : 2015/01/09 - (Rev. 2015/04/19)
  • Author : Autism Society of North Carolina
  • Contact : 919-865-5063


Autism Society of NC in-network provider for State Health Plan for teachers and state employees covering treatment for Autism Spectrum Disorder.

Main Document

The Autism Society of North Carolina is proud to be an in-network provider for the State Health Plan for teachers and state employees, which began covering treatment for Autism Spectrum Disorder on January 1.

The covered treatment, Applied Behavioral Analysis (ABA), has been shown to be widely effective and safe, based on scientific research.

ABA promotes the acquisition of socially appropriate behaviors and the reduction of interfering behaviors by systematically changing environmental variables and strengthening appropriate replacement behaviors.

"Autism insurance coverage is a very important issue to families. Our organization has worked with the General Assembly for many years to pass autism insurance legislation," said Tracey Sheriff, CEO of the Autism Society of North Carolina (ASNC). "While our legislative efforts are not complete, we applaud the State Health Plan for adding autism treatment as a benefit to families."

ASNC will begin providing ABA under the State Health Plan (SHP) in Raleigh and surrounding areas and then expand services throughout the state based on need. For more information about treatment through ASNC, families are asked to complete an interest form at bit.ly/ASNCformSHP so that a member of ASNC's Clinical Services team can contact them.

"The benefits of ABA treatment for children and young adults on the autism spectrum are proven effective and supported by research," said Dr. Aleck Myers, ASNC Clinical Director. "As an in-network provider, our clinical team is excited to begin serving state employees through this new benefit."

The SHP will cover the benefits under the following guidelines:

  • The member receiving ABA benefits must be younger than 26.
  • The member should have a diagnosis of autism, provided by a licensed physician or doctoral-level clinical psychologist.
  • The treatment must be deemed medically necessary by the Mental Health Care Manager.
  • All ABA services must be directly provided or overseen by a licensed psychologist or licensed psychological associate with sufficient training and expertise in autism and ABA.

The ABA benefit has a maximum coverage of $36,000 per year. Coverage is subject to copay, deductible, and coinsurance as applicable.

  • Autism Spectrum Disorder (ASD) is a lifelong developmental disability that typically appears during the first three years of life. Recent studies estimate that up to 1 of every 58 children born in North Carolina will be affected by ASD.
  • For more than 44 years, the Autism Society of North Carolina has worked to address areas of need and expand services for the autism community in North Carolina. ASNC works to directly improve the lives of individuals affected by autism by providing advocacy, education, and services.
  • For more information, call 1-800-442-2762 or visit www.autismsociety-nc.org

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