Cigna’s Autism Coverage
An Overview
What is autism?
 Autism Spectrum Disorders (ASD) are a range of complex behavioral
disorders that can cause serious, lifelong impairments in behavior, cognition,
and social development.
– Prevalence: 1 in 110 children (CDC study released December 2009)
– More common than Down Syndrome and Spina Bifida
 Autism spectrum disorders, also called pervasive developmental disorders,
are identified by ICD-9 codes in the 299.xx range
– Autism or autistic disorder: 299.00, 299.01
– Childhood disintegrative disorder (Heller’s syndrome): 299.10, 299.11
– Other specified pervasive development disorder including Asperger’s disorder and Rett’s
disorder: 299.80, 299.81
– Unspecified pervasive development disorder: 299.90, 299.91
 Autism spectrum disorders are separate and distinct from developmental
delays and learning disabilities
– Cigna considers developmental delays to be slower than expected attainment of
developmental milestones, but progress occurs in the anticipated sequence. Learning
disabilities are conditions that affect educational performance.
– A child can have a developmental delay or learning disability without having autism
– Children with autism often also have developmental delays or learning disabilities
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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How is autism treated?
 There is no cure for autism; however, the condition is most commonly
managed through a combination of medical, behavioral, pharmacological,
and educational interventions.
Medical
Treatments
• Clinical history, physical exams, office visits
• Hearing, communication, and cognitive assessments
• Lab/radiology tests to rule out other underlying conditions
• Speech, physical, occupational therapy
Behavioral
Treatments
• Psychotherapy to manage behavioral issues
• ABA therapy or other early intensive behavioral intervention
Pharmacological
Treatments
Educational
Interventions
• Prescription drugs to manage behavioral issues
• Early intervention programs (birth to 3)
• Individualized Education Plans
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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Does Cigna Provide Coverage for Autism?
 Cigna’s standard benefits cover services to diagnose autism as well as some
treatments for autism
Diagnosis/
Medical
Treatments
• Clinical history, physical exams, office visits
• Hearing, communication, and cognitive assessments
• Lab/radiology tests to rule out other underlying conditions
Medical
Treatments
• Speech, physical, occupational therapy
Behavioral
Treatments
• Psychotherapy to manage behavioral issues
Behavioral
Treatments
• ABA therapy or other early intensive behavioral
intervention
Pharmacological
• Prescription drugs to manage behavioral issues
Treatments
Educational
Interventions
• Early intervention programs (birth to 3)
• Individualized Education Plans
Covered same as
any other illness
Not covered unless
required by law
Covered same as any
other mental health
condition
Not covered unless
required by law
Covered same as any
other medication
Not covered unless
required by law
“Not covered unless required by law” – only applicable to insured plans sitused in states with autism mandates
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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Services Offered by Autism Team
• Educates customer about plan and coverage
• Helps with provider search for independently licensed individuals who work with ASD
• Locates community based support groups
• Offers Cigna Autism Awareness Series —telephonic seminars focusing on aspects of
parenting and
intervention
• Resources available on Cigna.com/autism, cignabehavioral.com
and other online
sites.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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© 2011 Cigna