Health insurance companies provide a variety of different “products” depending on who contracts to offer the plan (you or your employer), who absorbs the “risk” for costs incurred by the members and who regulates the plan (state or ERISA; see question above regarding Colorado’s autism benefits mandate).

Basically, you should list the health care needs of your child and determine whether the plan includes benefits to address those needs.  If your child needs occupational (OT) and speech therapies (SLT), look at the plan’s description of those benefits.  Look at what is covered and what is excluded within the descriptions of OT and SLT.  Also look at what the Exemptions section of the plan describes.  Look at rules regarding pre-existing conditions.  Usually, there is a waiting period for coverage of those services that address a pre-existing condition.  If you are looking for autism treatment outside of a state regulated plan that provides autism treatment coverage, look at the Network Provider List.  Identify providers that the plan does cover that have experience with autism spectrum disorders or at a minimum, experience with children or adults with disabilities.

Synthesizing

Be sure that if your company has a benefits representative (or Human Resources person) you make that person aware of your loved ones’ special health care needs.  They will influence which plans your employer chooses.  Knowing that your family needs certain kinds of care will help them to advocate on your behalf, not only in the choice of plans the employer offers, but also in assistance negotiating benefits with the plan later.