HB 2265 -- Health Insurance Coverage for Autism

Sponsor:  Grisamore

This bill requires all health insurance carriers to provide
coverage to their members for autism spectrum disorder treatments
by January 1, 2009.  Insurers are prohibited from denying
coverage for individuals who are diagnosed with the disorder.
Deductibles, co-insurance, and benefit limits for the disorder
cannot exceed those assessed for a general physical illness under
the health insurance plan.

Coverage for the disorder:

(1)  Can be subject to exclusions and limitations such as
coordination of benefits, provider requirements, restrictions for
services provided by family members, and reviews of necessity for
services being utilized;

(2)  Will be limited to the treatment plan prescribed by the
treating physician and insurers can request a copy of the updated
treatment plan once every six months;

(3)  Will be provided for individuals who are diagnosed with the
disorder prior to turning nine years of age and eligible
individuals can receive plan benefits and coverage until they
reach 16 years of age;

(4)  Will include behavioral therapies with a $50,000 per year
maximum benefit.

Certain supplemental insurance policies are exempt from the
provisions of the bill including life care contracts and
accident-only, specified disease, hospital with a fixed daily
benefit, Medicare supplement, long-term care, short-term major
medical of six months or less, or any other supplemental
policies.

Missouri House of Representatives
94th General Assembly, 2nd Regular Session
Last Updated October 15, 2008 at 3:12 pm