Florida's Autism Insurance Law (Steven A. Geller Act) Explained, Section by Section

If your child has autism or Down syndrome and your family has health insurance through a Florida employer, one state law shapes much of what your plan has to do: the Steven A. Geller Autism Coverage Act. It is short, it has not changed in years, and it leaves out more families than most parents expect. This guide walks through it section by section in plain English, so you know what to ask your plan and what the law can and cannot do for you.

What is the Steven A. Geller Autism Coverage Act?

The Geller Act is the name Florida gives to two statutes that say the same thing for two kinds of coverage:

• Section 627.6686, Florida Statutes, which applies to health insurers.
• Section 641.31098, Florida Statutes, which applies to health maintenance organizations (HMOs).

Subsection (1) of each says the two sections "may be cited as the 'Steven A. Geller Autism Coverage Act.'" The law was passed in 2008 (chapter 2008-30) and applies to plans "issued or renewed on or after April 1, 2009." When people say "Florida's autism insurance mandate," this is the law they mean.

In short, the law requires certain group health plans to cover screening for autism and treatment of autism spectrum disorder and Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis (ABA), for children and some teens. Each part of that sentence has limits, and the limits are where families get surprised.

Which health plans does the law apply to?

This is the most important question, because the law only reaches some plans. Under 627.6686(2)(d), a covered "health insurance plan" is a group health insurance policy or group benefit plan from an insurer, and it expressly includes the State Group Insurance Program for Florida state employees. The same subsection then excludes three kinds of plans:

• plans "offered in the individual market" (for example, a plan you buy yourself on HealthCare.gov);
• plans that are "individually underwritten"; and
• plans "provided to a small employer." Florida law defines a small employer as one with an average of 1 to 50 eligible employees (s. 627.6699).

The insurer must also be licensed and regulated in Florida (627.6686(2)(e)). That leaves out two very large groups of families. The first is anyone in a self-funded (self-insured) employer plan, where the employer pays claims and an insurance company or administrator only runs the plan. Those plans fall under the federal law ERISA, not Florida insurance law. The second is anyone whose employer plan was issued in another state.

The Florida Department of Financial Services (DFS) puts it plainly: it "does not have authority over self-insured plans under the Employee Retirement Income Security Act of 1974, employer group health plans issued outside the State of Florida, Medicaid, Medicare, Tricare, or any other governmental health plan."

If you are not sure which row you are in, the guide on fully insured vs self-funded plans shows how to find out in a few minutes.

Is my child old enough, or too old, to be covered?

The law covers an "eligible individual," defined in 627.6686(2)(c) as:

"an individual under 18 years of age or an individual 18 years of age or older who is in high school who has been diagnosed as having a developmental disability at 8 years of age or younger."

In practice that means:

• Children under 18 are eligible if the other conditions are met.
• A young person who is 18 or older can stay eligible while still in high school, but only if they were diagnosed with a developmental disability at age 8 or younger.
• Once a young adult leaves high school, the state mandate no longer requires coverage. Some plans still cover ABA for adults by choice, so check your plan.

Here is a simple example. A 17-year-old diagnosed with autism at age 4, in a fully insured large-group plan, is an eligible individual. On their 18th birthday, while still a high school senior, they remain eligible. A 19-year-old who was first diagnosed at age 12 would not meet the "diagnosed at 8 or younger" test, even in high school. The guide to coverage after 18 covers this in more depth.

Which conditions and treatments does the law cover?

Subsection (3) requires coverage of two things:

1. Screening: "Well-baby and well-child screening for diagnosing the presence of autism spectrum disorder."
2. Treatment: "Treatment of autism spectrum disorder and Down syndrome through speech therapy, occupational therapy, physical therapy, and applied behavior analysis."

The law still uses older autism labels

The statute defines autism spectrum disorder as "any of the following disorders as defined in the most recent edition" of the DSM: autistic disorder, Asperger's syndrome, and pervasive developmental disorder not otherwise specified. Those are the pre-2013 names. The current DSM-5 combined them into a single diagnosis, autism spectrum disorder. The law was never rewritten to match, so if a plan ever questions a DSM-5 autism diagnosis because of the wording, ask the plan to explain its position in writing.

Down syndrome was added in 2016

The words "and Down syndrome" were added by chapter 2016-222, Laws of Florida. This matters because some national insurer policies treat ABA for Down syndrome without a co-occurring autism diagnosis as not medically necessary. In a fully insured Florida large-group plan or HMO, the statute requires coverage for eligible children. In a self-funded plan, the plan's own policy usually controls. The guide on ABA for Down syndrome explains that gap.

"Habilitative" is not a valid reason to deny

Many children in ABA are learning skills for the first time rather than regaining lost ones. That is called habilitative care. Subsection (4)(c) says coverage "may not be denied on the basis that provided services are habilitative in nature."

Who is allowed to provide ABA under the law?

Subsection (3)(b) says ABA "shall be provided by an individual certified pursuant to s. 393.17 or an individual licensed under chapter 490 or chapter 491." In plain terms:

• Section 393.17 is how Florida recognizes behavior analyst certification from a national nonprofit certifying body, which in practice is the Behavior Analyst Certification Board (BACB). Florida does not issue its own behavior analyst license, so the credential to look for is BACB certification, such as BCBA.
• Chapter 490 covers licensed psychologists.
• Chapter 491 covers licensed clinical social workers, marriage and family therapists and mental health counselors.

The statute does not mention Registered Behavior Technicians (RBTs). Whether an RBT can deliver sessions under a BCBA's supervision is set by your plan's contract and medical policy, not by the Geller Act. Payer medical policies, such as Cigna's (Evernorth) ABA policy, describe treatment delivered under a behavior analyst's supervision, often 1 to 2 hours of supervision for every 10 hours of direct treatment.

You can check a BCBA or RBT on the BACB's free certificant registry, and check a Florida psychologist or clinical social worker on the Florida Department of Health license lookup.

What does the treatment plan have to include?

Subsection (4)(a) limits coverage "to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan." Subsection (7) lists what that plan must contain:

• a diagnosis;
• the proposed treatment by type;
• the frequency and duration of treatment;
• the anticipated outcomes, stated as goals;
• how often the plan will be updated; and
• the signature of the treating physician.

In practice, the ABA provider's clinical team writes the detailed behavior plan, and your child's doctor provides the prescription or order the plan requires. Plans differ on the exact paperwork, so ask your plan what form the physician's part should take. The article on whether ABA needs a doctor's prescription walks through it.

Does the law put a dollar cap on ABA?

This is the part of the law most often misquoted online. Subsection (4)(b) does contain an annual dollar limit and a total benefit limit, and many websites still repeat those original figures as if they were today's numbers. Three facts change the picture:

1. The limits are indexed. Subsection (8) says the maximum benefit "shall be adjusted annually on January 1 of each calendar year" to reflect changes in the medical component of the Consumer Price Index. So the figures written in the statute are a 2008 starting point, not a current number. We found no state publication of the current adjusted figure, so we do not print one.
2. Federal law restricts dollar caps. Under federal rules (45 CFR 147.126), group health plans and insurers "may not establish any lifetime limit on the dollar amount of essential health benefits," and may not set annual dollar limits on those benefits either. Federal mental health parity law also restricts dollar limits on mental health benefits, and autism is a DSM condition.
3. Many plans no longer apply the caps. For example, the 2025 Florida State Employees' PPO booklet covers ABA for autism and Down syndrome and lists the lifetime benefit maximum as "Not Applicable."

The honest summary: Florida's statute still contains dollar limits, but federal rules restrict dollar caps on many benefits, and most plans no longer apply them to ABA. Whether a specific plan may legally do so depends on how it defines essential health benefits and on parity rules. Your plan documents are the final word. See do Florida's ABA dollar caps still apply for the full explanation.

What can my plan still do under the law?

The Geller Act requires coverage, but it does not require a plan to approve every request. Subsection (4)(d) lets plans apply their general exclusions and limitations, "including, but not limited to":

• coordination of benefits (when your child has two plans);
• participating provider (network) requirements;
• restrictions on services provided by family or household members (insurer version only); and
• utilization review, "including the review of medical necessity, case management, and other managed care provisions."

That is why ABA usually needs prior authorization, why plans ask for assessments and progress data, and why approved hours can be lower than what was requested. The law does give families three protections:

• Cost-sharing parity. Under subsection (5), deductibles, coinsurance and dollar limits for the required coverage may not be "less favorable" than those for physical illnesses generally covered by the plan.
• No discrimination. Under subsection (6), an insurer may not refuse to issue, renew or contract with someone, or restrict their coverage, "because the individual is diagnosed as having a developmental disability."
• No narrowing of other benefits. Subsection (9) of the insurer statute says the section "may not be construed as limiting benefits and coverage otherwise available" under the plan.

Has the law changed recently?

No. As of October 2026, the last law to amend either section is chapter 2016-222, the 2016 law that added Down syndrome. The 2026 Florida Statutes show no amendments to 627.6686 or 641.31098 from 2017 through 2026. Separate debates in 2026 about Medicaid ABA, including the state's ABA Task Force, do not change this law for private insurance.

How do I find out what my child's plan covers?

The statute tells you the floor. Your plan documents tell you what your family actually has. A practical order of steps:

1. Find out whether the plan is fully insured or self-funded. Ask your HR or benefits office that exact question. In the Summary Plan Description, look for the words "self-funded," "self-insured," "ASO" or "administered by."
2. Call the member services number on the insurance card. Ask whether ABA is covered for your child's diagnosis, whether prior authorization is needed, what your deductible, copay or coinsurance is, and whether there are visit, hour or age limits. Ask for the answer in writing.
3. Ask for the plan's ABA medical policy. It explains what the plan needs to approve hours.
4. If you think a fully insured plan is not following the law, you can call the DFS Insurance Consumer Helpline at 1-877-693-5236. For self-funded employer plans, DFS refers families to the U.S. Department of Labor's Employee Benefits Security Administration, toll-free 1-866-444-3272.

This guide explains the law in general terms. For a decision about your own child's coverage, the plan document and your plan's appeal process decide; for a legal dispute, talk to a Florida attorney.

How Hope Center can help

Reading your own plan is easier with someone who does it every day. Hope Center for Behavior Change offers a free benefits check: we contact your plan, confirm whether ABA is covered and what your share is likely to be, and explain the answer in plain language. We work with Blue Cross Blue Shield (Florida Blue), Aetna, Cigna (Evernorth), UMR, Personify Health and TRICARE East. Your costs depend on your plan, and we offer self-pay with a sliding scale. See insurance at Hope Center, or request your free benefits check or call 561-337-8865.