Treatment for Autism now covered under some insurance policies

You may have heard some talk about a new law that will affect the way in which insurance companies will cover therapy for Autism, Pervasive Developmental Disorder (PDD) and Autism Spectrum Disorder (ASD) or you may have even received notice in the mail from Regional Center discussing this new law.  If you are confused about it, you aren't the only one.  He is a short synopsis of the new law. 

The Autism Insurance Act comes into effect on July 1, 2012.  This Act now requires health insurance plans to provide coverage for behavioral health treatment for Autism, PDD and ASD.  Among other things, the Autism Insurance Act now specifically requires health insurance policies to provide coverage for all behavioral health treatment for Autism, PDD and ASD that is determined to be medically necessary, including applied behavioral analysis (ABA) and other evidence based behavior intervention programs.

There are certain limitations to the application of the Autism Insurance Act.  The most important limitations are as follows:

• The law does not apply to health insurance policies that do not provide mental health or behavioral health services to enrollees.
• The law does not apply to self-funded insurance plans provided by employers.
• The law does not apply to participants of the Medi-Cal program, the Healthy Families program or the Public Employees Retirement System (CalPERS).

In short, this law means that if you have a health insurance plan that falls within the scope of the Autism Insurance Act, the insurance company must provide the same service to a person with autism as it does to a person with a physical condition.  This includes providing coverage for ABA services.

This is NOT legal advice.  This blog provides general information about various issues related to health insurance and disability cases.  To discuss your particular circumstances and claim, please contact a lawyer in your area.