HB 376 Summary

• Prohibits health insuring corporations, sickness and accident insurers, and public employee benefit plans from excluding coverage for screening, diagnosis, and treatment of autism spectrum disorders when medically necessary and prescribed by a licensed health care professional.

• Requires coverage of habilitative/rehabilitative care, pharmacy care, psychiatric care, psychological care, therapeutic care, and counseling services for individuals diagnosed with autism spectrum disorders.

• Allows coverage to be subject to standard copayments, deductibles, and coinsurance, and permits a yearly maximum limitation of $36,000 on autism-related claims.

• Limits insurers to reviewing treatment no more than once every six months (unless the treating physician or psychologist agrees more frequent review is necessary) and requires insurers to pay for requested reviews.

• Exempts certain limited policies (disease-specific, hospital indemnity, Medicare supplement, disability income, short-term policies under six months) and allows insurers to opt out if actuarial documentation shows autism coverage costs increase their overall costs by more than 1% annually.