NC S1265

Requires all health benefit plans, including the State Health Plan for Teachers and State Employees, to provide coverage for diagnosis and treatment of autism spectrum disorders effective January 1, 2011.

Mandates coverage for behavioral care, pharmacy care, psychiatric care, psychological care, and therapeutic care when prescribed by a licensed physician or psychologist for individuals diagnosed with autism spectrum disorders.

Prohibits insurers from denying coverage based on treatments being habilitative or educational in nature, and prevents termination of coverage solely due to autism spectrum disorder diagnosis or treatment.

Sets a maximum annual benefit of $75,000 for behavioral therapy coverage, with co-payments, deductibles, and coinsurance provisions applying at rates no less favorable than other covered medical services.

Allows insurers to request treatment review no more than once every 12 months, except for inpatient services, with review costs borne by the insurer.