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PFA Insurance Guide

My Insurance is Covered by an Employer Self-Funded Plan

Employer Self-Funded Plan (Self-Insured) are regulated by the Federal government and are NOT subject to state mandates. Therefore, your employer Self-funded plan DOES NOT have to comply with Maryland mandated services, including Habilitative Services. However, many Self-Funded plans do offer an Autism benefit. Check with your carrier or benefits office to learn about what autism treatment/habilitative services are covered under your plan. These questions developed by the Maryland Insurance Administration may be helpful to you when speaking with your Carrier.

If your plan does not offer an Autism benefit, ask them to add it. Autism Speaks has a helpful tool kit offering tips on how to approach your Self-Funded plan.

If your employer is unwilling to add an autism treatment benefit you may want to consider purchasing a child only plan from the exchange, a broker or directly from a carrier. There are many considerations to make when purchasing a child only plan.

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