Cigna’s Autism Coverage

An Overview

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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

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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

PharmacologicalTreatments

• Prescription drugs to manage behavioral issues

EducationalInterventions

• Early intervention programs (birth to 3)• Individualized Education Plans

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Does Cigna Provide Coverage 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

Behavioral Treatments

• Psychotherapy to manage behavioral issues

PharmacologicalTreatments

• Prescription drugs to manage behavioral issues

EducationalInterventions

• Early intervention programs (birth to 3)• Individualized Education Plans

Covered same as any other illness

Covered same as anyother mental health

condition

Covered same as any other medication

Not covered unless required by law

Behavioral Treatments

• ABA therapy or other early intensive behavioral intervention

Not covered unless required by law

Medical Treatments

• Speech, physical, occupational therapyNot covered unless

required by law

Cigna’s standard benefits cover services to diagnose autism as well as some treatments for autism

“Not covered unless required by law” – only applicable to insured plans sitused in states with autism mandates

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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.

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