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Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Coverage for Special Needs in 2014

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Question: I have a son with Autism. We’ve had Kaiser for years. First as a fully funded plan so he was protected by CA AB88 in that there were no limits on his therapies. No we have a self funded plan which is regulated by ERISA and we are subject to limits. Being that I assume Kaiser will be a ‘grandfathered’ plan and exempt from ACA mandates, I am concerned that we will have to continue to deal with unfair limitations with my son’s therapies. When shopping for coverage, how can I guarantee that we will not be faced with limits on a 2014 policy? How does the ‘Government Option’ work? What is the best way to compare ALL plans available when dealing with a specific health issue?

Answer: Assuming your employer continues self-funding their employee health coverage, the plan will, as you say, be exempt form the ACA mandates and not cover autism treatments very well. Purchasing an ACA qualified individual plan, either in Covered California or off-exchange, will provide better coverage for autism and you will have to weigh that against the additional cost of purchasing coverage without employer cost sharing. You will be able to compare all plans the the Exchange and off-exchange on the CAHBA.com website, starting in September 2013.

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