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Tuesday, December 4, 2012

A Catch in Federal Employee Insurance

Previous posts have discussed the decision by the Office of Personnel Management (OPM) that ABA is a medical therapy, rather than an educational service, for purposes of the Federal Employee Health Benefits Program (FEHBP).  But there is a big catch.  At The Washington Post, Joe Davidson reports:
OPM, after excluding ABA from FEHBP as an educational service, will allow insurance companies to cover it as a medical treatment next year. Open season, during which employees can change insurance plans, ends Dec. 10.
“This decision by OPM, however, is only a partial victory, since they only allowed rather than required the insurance companies to cover autism treatment,” said J. David Cox, president of the American Federation of Government Employees, which has pushed for ABA coverage.
The problem for families is many insurance plans still will not cover ABA. OPM does not mandate it. As a result, coverage of ABA will be available in some places but not others. It will not be covered, for example, in the District, Maryland and Virginia, except in the Hampton Roads and Richmond areas, according to Autism Speaks, a science and advocacy organization.
“Out of 230 participating health plans, 67 chose to offer the ABA benefit in 2013,” according to the organization. ABA coverage will be available everywhere in only three states, Arkansas, Minnesota and New Mexico. It will be available in parts of 19 others. Everywhere else, parents and their children will be out of luck.