Autism Bulletin 2025-09 (for 2026 effective)

South Carolina Department of Insurance Capitol Center 1201 Main Street, Suite 1000 Columbia, South Carolina 29201 _________________________ Mailing Address: P.O. Box 100105, Columbia, S.C. 29202-3105 Telephone: (803) 737-6160 Bulletins are the method by which the Director of Insurance formally communicates with persons and entities regulated by the Department. Bulletins are departmental interpretations of South Carolina insurance laws and regulations and provide guidance on the Department’s enforcement approach. Bulletins do not provide legal advice. Readers should consult applicable statutes and regulations or contact an attorney for legal advice or for additional information on the impact of that legislation on their specific situation. HENRY MCMASTER Governor MICHAEL WISE Director BULLETIN NUMBER 2025-09 TO: All Insurers and HMOs Writing Accident and Health Insurance Coverage in South Carolina, including the State Health Plan FROM: Michael Wise Director of Insurance SUBJECT: Section 38-71-280, Autism Spectrum Disorder Maximum Benefit for Coverage for Behavioral Therapy DATE: October 1, 2025 ___________________________________________________________________________________ I. PURPOSE AND SCOPE OF THIS BULLETIN The purpose of this bulletin is to address a provision of S.C. Code Ann. § 38-71-280, added by 2007 S.C. Act No. 65. Subsection (E) requires that annual adjustments of the maximum benefit for coverage for behavioral therapy shall be made to reflect any change from the previous year in the Consumer Price Index. S.C. Code Ann. § 38-71-280 (E) provides as follows: “… Coverage for behavioral therapy is subject to a fifty-thousand-dollar maximum benefit per year. Beginning one year after the effective date of this act, this maximum benefit shall be adjusted annually on January 1 of each calendar year to reflect any change from the previous year in the current Consumer Price Index, All Urban Consumers, as published by the United States Department of Labor’s Bureau of Labor Statistics.” The South Carolina Department of Insurance has reviewed the current Consumer Price Index and determined that the maximum benefit for coverage for behavioral therapy shall be increased to $73,400 for the calendar year beginning January 1, 2026. II. QUESTIONS Any questions or concerns about this bulletin should be submitted in writing to the attention of: Emily Gatenby, ASA, MAAA Email: egatenby@doi.sc.gov Life, Accident, & Health Actuary South Carolina Department of Insurance 1201 Main Street, Suite 1000 Columbia, SC 29201