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having autism – Children with autism often also have developmental delays or learning disabilities Confidential, unpublished property of Cigna.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 2 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to manage behavioral issues • Early intervention programs (birth to 3) • Individualized Education Plans Confidential, unpublished property of Cigna.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 3 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 4 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 5 "Cigna" is a registered service mark and the "Tree of Life" logo is a service mark of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. 000000 00/11 © 2011 Cigna
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