PA Autism Insurance Act (Act 62)
An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in preliminary provisions, further providing for effect of act on existing laws; in life insurance, further providing for additional investment authority for subsidiaries; in casualty insurance, providing for autism spectrum disorders coverage and for colorectal cancer screenings coverage; in insurance holding companies, further providing for definitions, for acquisition of control of or merger with domestic insurer, for acquisitions involving insurers not otherwise covered and for standards and management of an insurer within a holding company system; providing for committee review; establishing the Insurance Restructuring Restricted Receipt Account; providing for community health reinvestment; and making a related repeal.
Prime Sponsor: Representative D. O'BRIEN

Last Action: Act No. 62
Section 635.2. Autism Spectrum Disorders Coverage.

19 health insurance policy or government program covered under this
20 section shall provide to covered individuals or recipients under
21 twenty-one(21) years of age coverage for the diagnostic
22 assessment of autism spectrum disorders and for the treatment of
23 autism spectrum disorders.
24(b) Coverage provided under this section by an insurer shall
25 be subject to a maximum benefit of thirty-six thousand dollars
26($36,000) per year but shall not be subject to any limits on the
27 number of visits to an autism service provider for treatment of
28 autism spectrum disorders. After December30, 2011, the
29 Insurance Commissioner shall, on or before April1 of each
30 calendar year, publish in the Pennsylvania Bulletin an

1 adjustment to the maximum benefit equal to the change in the
2 United States Department of Labor Consumer Price Index for All
3 Urban Consumers (CPI-U) in the preceding year, and the published
4 adjusted maximum benefit shall be applicable to the following
5 calendar years to health insurance policies issued or renewed in
6 those calendar years. Payments made by an insurer on behalf of a
7 covered individual for treatment of a health condition unrelated
8 to or distinguishable from the individual's autism spectrum
9 disorder shall not be applied toward any maximum benefit
10 established under this subsection.
11(c) Coverage under this section shall be subject to
12 co- payment, deductible and coinsurance provisions, and any other
13 general exclusions or limitations of a health insurance policy
14 or government program to the same extent as other medical
15 services covered by the policy or program are subject to these
16 provisions.
17(d) This section shall not be construed as limiting benefits
18 which are otherwise available to an individual under a health
19 insurance policy or government program.
20(d.1) This section shall not be construed as requiring
21 coverage by insurers of any service based solely on its
22 inclusion in an individualized education program. Consistent
23 with Federal or State law and upon consent of the parent or
24 guardian of the covered individual, the treatment of autism
25 spectrum disorders may be coordinated with any service included
26 in an individualized education program. Coverage for the
27 treatment of autism spectrum disorders shall not be contingent
28 upon a coordination of services with an individualized education
29 program.
30(e)(1) This section shall apply to any health insurance