New York City
- Early diagnosis is critical in treating children with autism spectrum disorders (ASD), so new parents should know that new federal health reforms require many insurance plans to cover autism spectrum and developmental screenings for infants.
"Health experts estimate that as many as one of every 110 children have a diagnosis of ASD, so it is essential that new parents understand exactly what the law requires so that an early diagnosis is possible," Insurance Superintendent James Wrynn
ASD is defined as a neurobiological condition that includes autism, Asperger Syndrome, Rett's Syndrome or pervasive development disorders. It's estimated more than 60,000 New Yorkers have ASD.
"Under the new Affordable Care Act, autism screening for children at 18 and 24 months must be covered without having to pay out-of-pocket expenses when these services are delivered by a network provider. The new federal reforms also require well-baby and well-child visits with physician's visits every few months when a child is young," Wrynn said.
These new rules mean consumers cannot be charged a co-pay, co-insurance or have to meet a deductible to receive these services. The rules affect consumers who have new health plans or insurance policies which began on or after September 23, 2010.
Parents should also be aware that under the new federal reforms:
• Health plans are now prohibited from excluding coverage of pre-existing conditions for children ages 18 or younger.
• Lifetime dollar limits on essential health benefits have been prohibited for health plans issued or renewed on or after September 23, 2010, and annual dollar limits will be gradually phased out.
The new federal law supplements existing New York laws which directly impact health insurance coverage for ASD diagnosis and treatment.
New York's Autism Statute prohibits a health maintenance organization (HMO) or insurer from excluding coverage for the diagnosis and treatment of medical conditions otherwise covered by a policy.
A second law, known as Timothy's Law, requires group health insurance policies and contracts to provide coverage for the diagnosis and treatment of mental health conditions, including ASD, when care is provided in a hospital, a facility issued an operating certificate by the Commissioner of Mental Health, a facility operated by the Office of Mental Health, or when care is provided by a psychiatrist, psychologist or licensed clinical social worker.
Additional information about ASD, including how to recognize warning signs in infants, can be found at www.nyacts.com, the website for NYActs, the state initiative for adults and children on the autism spectrum.
Consumers can obtain more information on insurance-related issues on the Insurance Department's website, www.ins.state.ny.us, or by calling the Department's
Consumer Services Bureau from 9 a.m. to 5 p.m., Monday through Friday toll-free at 800-342-3736.