Will my insurance cover this?

A common question from families interested in admission to CA’s Children’s Programs is around matters of insurance coverage. Thanks to House Bill 2467 in 2011 and the extension of the law with House Bill 1940 in 2015, coverage for Applied Behavior Analysis (ABA) services is required by most Virginia-based health insurance packages utilized by families for children with a diagnosis of Autism Spectrum Disorder up through age 10.

Please note that there are some exceptions to the coverage mandate. Certain plans may not be included. Additionally, CA is not currently able to accept Medicaid or Medicaid-affiliated managed care plans for coverage of program fees.

If you would like more information regarding your particular health insurance benefits and how you might be able to utilize them for coverage of program fees at CA, please complete the form below. You will be asked to upload a photo (front and back) of your insurance card. Someone from CA will get back to you within two business days regarding your inquiry.

Insurance Screening Form

Child's Name*
First Last
Child's Date of Birth*
Month
Day
Year

This should be the DOB for the person listed above.
Parent's Name (Insurance Carrier)*
First Last
This should be the person under whose insurance the child is covered.
Parent's Date of Birth*
Month
Day
Year

This should be the DOB for the person listed above.
Primary Contact (If different from above)
First Last
Phone number for primary contact listed above.*
Email for primary contact listed above.*
Enter Email Confirm Email
Insurance Provider*
Front of Insurance Card*
Max. file size: 256 MB.
Should be submitted in jpg, gif, png, or pdf format
Back of Insurance Card*
Max. file size: 256 MB.
Should be submitted in jpg, gif, png, or pdf format
Disclosure (Please Initial)*

By providing my initials, I confirm the following: 1. By submitting this form, I am transmitting electronically the personal health information of myself or of a child for whom I am the parent or guardian. 2. I also understand that by submitting this form, I am granting CA Human Services and its employees permission to review this personal health information for the purposes of potential admission and eligibility for the Children's and Adult Programs. 3. I understand that someone from CA Human Services will contact me within two business days following submission of this form with further information regarding insurance eligibility.
Today's date*
Month
Day
Year

Will my insurance cover this?

Insurance Screening Form

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