South Carolina Insurance Requirements for Autism Spectrum Disorder

The information below is collected from state statutes and regulations. The information is reviewed on an annual basis. Please be advised that laws, regulations, and policies may change at any time, so always check with your state for the most up-to-date information.

Note: Certain insurance plans are exempt from state mandates. Please contact your plan administrator to see if your plan includes state mandated autism spectrum disorder benefits.

Specific Insurance Mandate

The state of South Carolina has a specific autism mandate.

The mandate requires a health insurance plan to provide coverage for the treatment of autism spectrum disorder. To be eligible for benefits and coverage, an individual must be diagnosed with autistic spectrum disorder at age eight or younger. The benefits and coverage provided must be provided to any eligible person under sixteen years of age.

Note: Speech language services are not specifically defined in the statute. Coverage is "limited to treatment that is prescribed by the insured's treating medical doctor in accordance with a treatment plan." Although behavioral therapy is not specifically defined, the statute does set out a cap of $50,000 per year for coverage of behavioral therapy.