State Insurance Legislation

Several states have enacted legislation relating to the use of private insurance for Part C services.

• Massachusetts mandates that both indemnity and managed care plans cover $5,200 in early intervention services per year per child and an aggregate benefit of $15,600 over the total enrollment period.
• Provisions Respecting Domestic Companies
• Non-Profit Hospital Service Corporations
• Medical Service Corporations
• Health Maintenance Organizations
• Connecticut requires coverage of Part C services up to $3,200 annually and exempt these costs from counting against any lifetime caps in a family's policy.
• Virginia also requires coverage of Part C services up to $5,000 annually and exempt these costs from counting against any lifetime caps in a family's policy. The state also applies these provisions in a separate act to the insurance program for state employees.
• New Hampshire requires coverage for Children's Early Intervention Therapy Services up to $3,200 per child per year not to exceed $9,600 by the child's third birthday.
• New Mexico requires coverage for children, from birth through three years of age, for or under the family, infant, toddler program administered by the department of health, provided eligibility criteria are met, for a maximum benefit $3,500 annually for medically necessary early intervention services. The services are provided as part of an individualized family service plan and delivered by certified and licensed personnel working in early intervention programs that are approved by the department of health. No payment shall be applied against any maximum lifetime or annual limits specified in the policy, health benefits plan or contract.
• New York requires insurers to reimburse early intervention services if they are otherwise covered under a policy and exempts these payments from counting against any lifetime caps.
• Indiana also requires insurers to reimburse early intervention services if they are otherwise covered under a policy and exempts these payments from counting against any lifetime caps
• Rhode Island requires coverage of Part C services up to $5,000 annually per dependent child and exempts these costs from counting against any lifetime cap in a family's policy.
• HMO's
• Accident and Sickness Insurance Policies
• Non-Profit Medical Service Corporations
• Non-Profit Hospital Service Corporations