More on Autism, Cancer Bill

The new Pennsylvania law mandating insurance coverage for autism spectrum disorders also requires that insurance companies cover colon cancer screenings. It also outlines statutory requirements for the proposed merger of Highmark Blue Shield and Independence Blue Cross.

Autism Insurance Coverage Mandate

The law requires insurance coverage for the diagnosis and treatment of autism spectrum disorders for individuals under twenty-one years of age, including any medically necessary pharmacy care, psychiatric care, psychological care, rehabilitative care and therapeutic care. Coverage will be capped at 36 thousand dollars per year, and there are no limits on the number of treatments. In 2012, the cap will be adjusted to match the Consumer Price Index. Insurers have to accept as a participating provider any autism service provider within its service area.

Colon Cancer Coverage Mandate

The law requires insurance coverage for colorectal cancer screening for individuals who are fifty years of age or older, or those under fifty years of age who are at high or increased risk for colorectal cancer. Coverage includes a colonoscopy, sigmoidoscopy or any combination of colorectal cancer screening tests at a frequency determined by a treating physician.

Blues Merger

The law ensures that the Insurance Department has appropriate oversight over the merger or consolidation of Blues Plans. It also allows the Senate Banking and Insurance Committee and the House Insurance Committee to receive and review all filings submitted to the Department of Insurance and develop written comments and recommendations on the merger filings. And it requires the Insurance Commissioner to determine that any approved merger will result in a 'sustained benefit’ to its policyholders.

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