Rep. Roe to head government officials at Legislative Breakfast
United States Rep. Phil Roe will lead government officials in updating those attending the fourth annual Legislative Breakfast on current affairs affecting local citizens.Read more
#1 Feb 25, 2013
EVERYONE -- would you please share our group on your Facebook page? We need to get more and more people from across the state -- every corner of it! Every single little town and village and big city and farm! Anyone who wants to support the autism community.... service providers, family, teachers, doctors.... Can you help? Here we are -- please encourage people to join us!
#2 Feb 25, 2013
Friends -- >>>PLEASE READ. This will help you understand what this bill could mean to you and your family, and it might not mean what you think.
If you have not read this, please take the time. This is the most important information in this group.
So -- our autism insurance bill, SB1286/HB1265. If it passes into law as written, how could it potentially help your family and friends? Well, if you have a private, fully-funded health insurance plan (more on that in a minute), it would mean -- if the bill passes intact -- it would mean that a person with a diagnosis of autism would be entitled to
(A) Behavioral health treatment;
(B) Pharmacy care;
(C) Psychiatric care;
(D) Psychological care; and
(E) Therapeutic care (including speech, OT, and PT).
There would be no fiscal limits to coverage, and no age limits to recipients of care.
This is dream coverage, I have to tell you. Almost nobody has this in the country, at least not with no age limit and/or no dollar limits. If we got this, we would be one of the best places to live in the United States as far as insurance coverage for autism treatment goes. If there is insurance coverage better than this anywhere on the planet, I don't know what it would look like. I fall asleep dreaming of insurance coverage like this for us all.
Now we need to talk about a hard reality, the fact that some insurance plans are NOT regulated by state law and will not be impacted by any bill we pass in TN. These plans, known as self-funded insurance plans, are regulated by ERISA law, which is Federal and are not subject to state law in any way. Under a self-insured plan, the employer is responsible for collecting or funding a pool of premiums.
With a fully insured plan, which are absolutely state-regulated and the coverage listed above would apply if passed, the employer pays all or part of the premium to an insurer, and the insurer pays claims from the pool of premiums it collects from everyone it insures.
After this bill is passed (I sound pretty sure, don't I?) and we become the 33rd or 34th or 35th state to have this type of legislation, we will be closer to the point where we in the insurance-wisher-club believes the federal government *must* address ERISA law, because there are just too many loopholes in self-funded plans, and too many people are going with less and less coverage on the whims of their plan providers. And we will fight, I promise.
Self-funded plan silver lining? There are people who have been able to *convince* their employers to add autism insurance benefits to self-funded plans. There is a road map how to do it, too, and I'll pull that out later this week if anybody would like to talk about it.
In a very big nutshell -- this is possibly the longest Facebook post I have ever written in my life -- this nutshell sums it up, I think. Please let me know if I can help you figure anything out, or if you have any questions. Meantime? Keep fighting. Nobody is stronger than an autism family.
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