How do I know if my plan is fully insured or self-funded?

Your ID card will typically look the same either way. KFF advises checking your plan documents or asking your human resources department. A self-funded plan is one where the employer pays claims directly. Large employers use self-funding more often than small ones.

Can a plan impose copays or limits only on autism treatment?

Not under the Colorado statute. Coverage cannot be subject to dollar limits, deductibles or coinsurance that are less favorable than those for physical illness generally. A carrier also cannot exclude autism or add authorization requirements that effectively exclude coverage.

Who has to prescribe ABA for insurance to pay?

Colorado's statute says treatment for autism spectrum disorders must be prescribed or ordered by a licensed physician or licensed psychologist. The plan also looks for a treatment plan from an autism services provider, prescribed after a comprehensive evaluation or reevaluation, with the diagnosis, type and frequency of treatment, outcome goals and an update schedule.

What do I do if my insurer denies ABA?

Read the denial notice. For a fully insured plan, it must give the specific reasons, the plan provisions relied on, and your right to appeal. File an internal appeal. If it is denied, you can ask for an independent external review within four months of the denial notice. For a self-funded plan, federal rules give you at least 180 days to file an appeal.

How long does an external review take?

Under Colorado law, the independent reviewer must issue a determination within 45 calendar days of the request, or within 72 hours for an expedited review. The carrier pays for the review, and the decision is binding on the carrier and the individual.

Does TRICARE cover ABA near Buckley Space Force Base?

Yes, through the TRICARE Autism Care Demonstration. A TRICARE-authorized provider diagnoses autism and refers your child, and ABA services need pre-authorization. There are no yearly or lifetime caps on the amount of ABA services TRICARE covers, and you pay the copayment or cost-share for your plan.

Does Private Insurance Cover ABA in Colorado? Aurora Guide

Q: Does private insurance cover ABA in Colorado?

Often yes, if your plan is regulated by the state. Colorado requires health benefit plans issued or renewed in the state to cover assessment, diagnosis and treatment of autism spectrum disorders for a child, including behavior training, behavior management and applied behavior analysis. Treatment must be medically necessary. Short-term limited duration plans and grandfathered individual plans are excluded from the definition.

The short version

Colorado law (C.R.S. 10-16-104(1.4)) requires health benefit plans issued or renewed in the state to cover assessment, diagnosis and treatment of autism spectrum disorders for a child. Behavior training, behavior management and applied behavior analysis are on the covered list.
The mandate reaches state-regulated plans. KFF says most state benefit mandates do not apply to self-insured ERISA plans. Your ID card will not tell you which kind you have, so check your plan documents or ask HR.
Colorado plans cannot apply dollar limits, deductibles or coinsurance to autism treatment that are less favorable than those for physical illness.
After an internal appeal is denied, you have four months to request an independent external review. The carrier pays for it, and the decision is due within 45 calendar days.
TRICARE covers ABA through its Autism Care Demonstration, with a referral and pre-authorization. The authorization letter covers six months at a time.

Does private insurance cover ABA in Colorado? For many Aurora families it does, and the answer depends on one fact most parents have never been told: whether the employer buys insurance from a carrier or pays claims itself. This guide explains how to find out, what Colorado law requires, how to appeal a denial, and how military families on TRICARE get ABA.

Information current as of October 2026. Your plan’s documents control, so confirm details with your carrier.

Step one: is your plan fully insured or self-funded?

Plan type	Who pays claims	Does the Colorado autism mandate apply?
Fully insured (employer, individual or marketplace plan from a carrier)	The insurance company	Yes, if it is a covered plan
Self-funded (also called self-insured)	The employer	Generally no. State benefit mandates mostly do not apply
Health First Colorado (Medicaid)	The state	Separate rules. See our Health First Colorado guide
TRICARE	The federal government	Separate program. See below

KFF explains that in a self-funded plan the employer pays enrollees’ claims directly, and these plans are “largely not required to comply with state insurance laws.” Federal laws, including the ACA, still apply. (KFF) KFF’s longer explainer says the same about benefit mandates, and that state insurance laws generally do apply to fully insured plans. (KFF)

Do not rely on the card. KFF notes that it will typically look the same as a fully insured plan’s card. Employers often hire an insurance company to run the network and process claims, which hides the arrangement. Check your plan documents or ask your human resources department.

What does Colorado’s autism mandate require?

The rule is in C.R.S. 10-16-104(1.4). The main points, from the statute text:

Who must cover. “All health benefit plans issued or renewed in this state” must cover assessment, diagnosis and treatment of autism spectrum disorders for a child. The definition of a health benefit plan leaves out short-term limited duration insurance and individual grandfathered plans.
What counts as treatment. Medically necessary services, including evaluation and assessment; behavior training, behavior management and applied behavior analysis by autism services providers; habilitative or rehabilitative care such as occupational, physical or speech therapy; pharmacy care; psychiatric care; psychological care; and therapeutic care. The statute says these treatments are not considered experimental or investigational.
Cost sharing. Coverage cannot carry dollar limits, deductibles or coinsurance that are less favorable than those for physical illness generally.
No back-door exclusions. A plan cannot exclude autism or add authorization requirements that would effectively exclude coverage, and a carrier cannot deny otherwise covered services because of an autism diagnosis.
Prescription. Treatment must be prescribed or ordered by a licensed physician or licensed psychologist, usually through a treatment plan from an autism services provider.
Same review rules. Coverage is subject to the plan’s utilization review and other terms that apply to other benefits.

(C.R.S. 10-16-104) The statute covers “a child.” Ask your carrier in writing which ages it applies, because we did not find a cutoff defined in the subsection we reviewed.

What does the insurer need before it pays?

Plans look for a diagnosis, a prescription and a treatment plan. Colorado’s definition of a treatment plan is one written by an autism services provider and prescribed by a physician or psychologist after a comprehensive evaluation or reevaluation. It must include the diagnosis, the type and frequency of treatment, outcome goals and an update schedule. (C.R.S. 10-16-104) Our assessment guide shows what goes into that plan, and our comprehensive assessment page describes how we start. If you are still waiting on a diagnosis, see our guide to starting ABA without a diagnosis.

How do I appeal a denial on a fully insured plan?

Read the denial notice. Colorado law requires it to state the specific medical basis and reasons, point to the plan provisions relied on, describe the review procedure and time limits, and tell you that you have the right to appeal.
Ask for the criteria. For a behavioral health denial, you are entitled on request, free of charge, to the medical necessity criteria.
File the internal appeal. Group plans must offer a two-level internal review, and the second level is optional. Individual plans have one level. A physician must evaluate a first-level appeal and consult a clinical peer, and nobody involved in the first decision may review it.
Request external review. After the internal appeal is denied, you have four months from the denial notice to ask for an independent external review. The carrier must pay the cost. The reviewer, accredited and certified by the state, must decide within 45 calendar days, or within 72 hours if the case is expedited because delay could seriously jeopardize health or the ability to regain maximum function. The decision binds the carrier and you.

(C.R.S. 10-16-113, C.R.S. 10-16-113.5)

Keep every letter, ask your provider for a letter of medical necessity, and write down the date you received each notice. The four-month clock runs from the notice.

What if my plan is self-funded?

The Department of Labor’s guide covers private-sector employer plans. It says you have at least 180 days to file an appeal, that the plan must give you the documents relevant to your claim free on request, and that decisions on appeals are due within 30 days for pre-service claims and 60 days for post-service claims, or 72 hours when care is urgent. It also says the external review process depends on whether the plan is self-funded or insured, and that non-grandfathered plans must provide external review by an independent party. Your denial notice describes the process for your plan. (U.S. Department of Labor)

Even when a self-funded plan is not bound by the state mandate, it may still choose to cover ABA. Ask HR for the plan’s autism and behavioral health benefits in writing.

How does TRICARE work for families at Buckley?

Buckley Space Force Base is in Aurora, in Arapahoe County. (Military OneSource) TRICARE covers ABA through the Autism Care Demonstration (ACD). Per the TRICARE site:

Your child needs a referral to the ACD and a pre-authorization for all ABA services. A new referral is needed every two years.
An approved diagnosing provider makes the diagnosis. That includes pediatricians, family practice physicians, developmental behavioral pediatricians, pediatric neurologists, psychiatrists, and licensed doctoral-level clinical psychologists.
Your child first receives an authorization letter for the ABA assessment. After the assessment and treatment plan, the letter covers six months of services. You request reauthorization every six months.
Four baseline outcome measures are required before ABA starts: the PDDBI, the Vineland Adaptive Behavior Scales, the Social Responsiveness Scale and a Parent Stress Index.
You pay your plan’s copayment or cost-share, and all ABA on one day counts as one copayment. TRICARE sets no yearly or lifetime caps on ABA.
Regional contractors are Humana Military (East, 800-444-5445) and TriWest Healthcare Alliance (West, 888-874-9378). Check which region you are in.

(TRICARE)

Active duty families must also enroll their child in their branch’s Exceptional Family Member Program and in the Extended Care Health Option, according to the same page.

Which plan should I ask our team about?

Tell us which kind of coverage you have when you contact us. We take all major insurance including Medicaid, have no waitlist and start families within two weeks of approval. If you are still deciding between providers, our guide to choosing an ABA provider and our guide to how many hours of ABA can help you ask better questions. See our in-home and in-clinic options.