If you or your spouse works for the State of Florida, your child's health coverage comes through the State Group Insurance Program, run by the Division of State Group Insurance (DSGI) within the Department of Management Services (DMS). That program has an unusual place in Florida's autism law, and it is worth understanding before you start ABA. This guide explains what the state plans cover, how the high-deductible option works for ABA, and who to call.
A note on sources: the details below come from the official plan booklets posted on MyBenefits, the State's benefits site. We say which year's booklet each fact comes from. Benefits can change each January, so always check the booklet for your plan year.
Does Florida's autism law cover state employee plans?
Yes, by name. Florida's autism coverage law, the Steven A. Geller Autism Coverage Act, defines the plans it covers as group health plans offered by an insurer, a definition that "includes the state group insurance program provided under s. 110.123" (s. 627.6686(2)(d), Florida Statutes).
That matters because the State's PPO plan is self-insured. The plan booklet says so directly: the PPO "is a self-insured plan. This means that claims are paid from a fund established by the State of Florida." Most self-insured employer plans fall outside Florida's mandate (see fully insured vs self-funded plans). The state plan is the exception, because the Legislature wrote it into the statute, and the booklet itself says the PPO Plan covers autism spectrum disorder and Down syndrome "in accordance with s. 627.6686, Florida Statutes."
What does the state PPO cover for autism and Down syndrome?
The 2025 State Employees' HDHP PPO booklet (effective January 1, 2025) describes the benefit this way: treatment for autism spectrum disorder and Down syndrome "is covered for an individual that was diagnosed as having a Developmental Disability at eight years or younger and is either; 1. Under 18 years of age, or 2. Eighteen years of age or older and in high school."
Coverage includes:
- well-baby and well-child screening for autism and Down syndrome;
- speech therapy, occupational therapy and physical therapy; and
- applied behavior analysis, "covered when provided by Applied Behavioral Analysts, psychologists, clinical social workers, and others within the scope of their license."
Coverage "is limited to treatment prescribed by the treating physician in accordance with a treatment plan." In practice, that means your child's doctor prescribes ABA and the provider's plan (goals, hours, how often it will be updated) supports it. The State's 2026 HDHP PPO booklet, which we reviewed in its Spanish edition posted with the MyBenefits header, carries the same autism and Down syndrome section and the same reference to s. 627.6686.
The 2025 HDHP booklet also lists the lifetime benefit maximum as "Not Applicable" and shows no annual dollar cap for autism treatment. Florida's statute still contains dollar figures, but they are indexed to inflation and federal rules now restrict dollar limits on many benefits. See do Florida's ABA dollar caps still apply.
Which health plans can state employees choose in 2026?
The State's 2026 Florida Benefit Guide lists these health plan options:
| Carrier | Options | Where to find ABA details |
|---|---|---|
| Florida Blue | Standard PPO, HDHP PPO | State Employees' PPO and HDHP PPO plan booklets on MyBenefits |
| Aetna | Standard HMO, HDHP HMO | That HMO's plan document on MyBenefits |
| Capital Health Plan | Standard HMO, HDHP HMO | That HMO's plan document on MyBenefits |
| UnitedHealthcare | Standard HMO, HDHP HMO | That HMO's plan document on MyBenefits |
HMOs have service areas, so not every option is available in every county; the Benefit Guide includes an HMO service area map. Each HMO also has its own provider network. If your child already sees an ABA provider, check that provider's network status for the exact state plan before you choose. The PPO vs HMO guide explains how network rules affect ABA.
What will ABA cost on the state high-deductible plan?
On the HDHP PPO, autism treatment is not free care. You pay the calendar year deductible first, then coinsurance. The 2025 HDHP booklet's summary lists "Autism" at "80% of Allowed Amt after CYD" in network and "60% of Allowance after CYD" out of network. In plain terms: after you meet the deductible, the plan pays 80 percent of its allowed amount when you use a network provider and you pay the remaining 20 percent, up to your out-of-pocket maximum. The 2026 HDHP booklet shows the same percentages. The 2024 State Employees' PPO booklet showed the same 80 percent and 60 percent for autism under the Standard PPO, after its (lower) deductible.
The 2026 Florida Benefit Guide says HDHP deductibles increased for 2026, to $1,700 for single coverage and $3,400 for family coverage. Because ABA is often several hours a week, many families on the HDHP meet the deductible early in the year. Our deductible math guide shows how that plays out over a year.
Out of network costs more. The booklet warns that "non-participating providers may bill insureds for any difference in the amount" between their charge and what the plan allows. That gap is on top of the 40 percent coinsurance.
Can I use an HSA or FSA for ABA as a state employee?
If you enroll in an HDHP, you can contribute to a health savings account (HSA). The 2026 Florida Benefit Guide lists HSA limits of $4,400 for individual coverage and $8,750 for family coverage, plus a $1,000 catch-up for ages 55 and older. It also lists a healthcare flexible spending account (FSA) with a $3,400 household maximum for 2026, and a limited-purpose FSA for HDHP members. Whether a specific ABA bill is a qualified medical expense follows IRS rules, which we explain in using an HSA or FSA to pay for ABA.
Who do I call with questions?
| Question | Contact |
|---|---|
| PPO medical benefits, claims, network providers | Florida Blue, (800) 825-2583, floridablue.com/state-employees |
| Enrollment, eligibility, adding a dependent, changing plans | People First Service Center, 866-663-4735 (weekdays 8 a.m. to 6 p.m. ET) |
| Plan administrator (Division of State Group Insurance) | (850) 921-4600 or (800) 226-3734 |
| HMO benefits | The member services number on your HMO card |
DSGI is the decision-maker. The booklet says DSGI "has full and final decision-making authority concerning eligibility, coverage, benefits, claims, and interpretation" of the plan. Florida Blue processes PPO claims for the State. The booklet's section on appealing a denied claim explains the steps and deadlines if ABA is denied; our appeals guide covers how to build a strong appeal.
One more state plan feature worth knowing: the PPO booklet describes a Patient-Auditor Program. If you find an overcharge on a claim, such as a charge for a service your child did not receive or an arithmetic billing error, you may receive part of what the plan recovers. Contact DSGI at (850) 921-4600 for the form. See how to read ABA codes on your EOB.
What should I do at open enrollment?
Open enrollment is the main time to switch plans. For the 2026 plan year it ran from October 13 to October 31, 2025, with changes effective January 1, 2026. Check MyBenefits for this year's dates. Before choosing:
- Ask your ABA provider which state plans it is in network with.
- Compare the Standard and HDHP options using your expected yearly ABA hours, not just premiums.
- Read the autism section of the booklet for the coming year.
- If you choose the HDHP, plan HSA contributions around the deductible.
Our open enrollment checklist has a full list.
How Hope Center can help
Hope Center for Behavior Change is in network with Blue Cross Blue Shield (Florida Blue), among other plans. A free benefits check confirms how your child's specific state plan covers ABA, what authorization it needs and what your share is likely to be. Costs depend on your plan; self-pay with a sliding scale is available. See insurance at Hope Center, request a free benefits check, or call 561-337-8865.