Blue Links for Employers

Mandated Autism Spectrum Disorder Benefits, Effective January 1, 2011

Massachusetts recently enacted a new law requiring health insurers to provide coverage for the diagnosis and treatment of autism spectrum disorders. In accordance with the new mandate, Blue Cross Blue Shield of Massachusetts will begin adding these benefits to most group plans on or after January 1, 2011. Specifically, new plans issued or delivered on or after January 1, 2011 will include these new autism benefits. For existing plans, benefits will be added upon the plan's renewal/anniversary date on or after January 1, 2011. Certain self-funded plans may have the option to exclude such benefits.

Benefits for the diagnosis of autism spectrum disorders will cover medically necessary assessments, evaluations, or testing. For individuals diagnosed with one of the autism spectrum disorders, our policies will cover the following medically necessary treatment services when provided or ordered by a licensed physician or psychologist:

  • Habilitative or rehabilitative care
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care

Benefits for the treatment and diagnosis of autism spectrum disorders will also meet the following requirements:

  • Annual or lifetime dollar limitations will be comparable to those applied for the diagnosis and treatment of physical disorders.

  • There will be no limits on the number of visits an individual can make to an autism services provider.

  • Benefits already available under a plan will not be limited due to the addition of these new benefits.

Benefits will not be provided to reimburse individuals for services related to the treatment and diagnosis of autism spectrum disorders when provided by school personnel for an individualized education program (IEP).

If you have any questions regarding these benefits, please contact your account executive.

Blue Cross Blue Shield of Massachusetts

Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association.
® Registered Marks of the Blue Cross and Blue Shield Association.
© 2012 Blue Cross and Blue Shield of Massachusetts, Inc., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.
Landmark Center, 401 Park Drive, Boston, MA 02215-3326 | 800-262-BLUE (2583)
Terms of Use, Privacy & Security | Accessibility