Sec. 7.1. (a) As used in this section, "covered individual" means an individual who is:
(1) covered under a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
(2) entitled to health services under a contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter.
(b) As used in this section, "autism spectrum disorder" means a neurological condition, including Asperger's syndrome and autism, as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.
(c) A self-insurance program established under section 7(b) of this chapter to provide health care coverage must provide a covered individual with coverage for the treatment of an autism spectrum disorder. Coverage provided under this section is limited to treatment that is prescribed by the covered individual's treating physician in accordance with a treatment plan. A self-insurance program may not deny or refuse to issue coverage on, refuse to contract with, or refuse to renew, refuse to reissue, or otherwise terminate or restrict coverage on, an individual under an insurance policy or health plan solely because the individual is diagnosed with an autism spectrum disorder.
(d) A contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter must provide a covered individual with services for the treatment of an autism spectrum disorder. Services provided under this section are limited to treatment that is prescribed by the covered individual's treating physician in accordance with a treatment plan. A prepaid health care delivery plan may not deny or refuse to provide services to, or refuse to renew, refuse to reissue, or otherwise terminate or restrict services to, an individual solely because the individual is diagnosed with an autism spectrum disorder.
(e) The coverage required by subsection (c) and services required by subsection (d) may not be subject to dollar limits, deductibles, copayments, or coinsurance provisions that are less favorable to a covered individual than the dollar limits, deductibles, copayments, or coinsurance provisions that apply to physical illness generally under the self-insurance program or contract with a prepaid health care delivery plan.
As added by P.L.148-2001, SEC.1. Amended by P.L.188-2013, SEC.2.
Structure Indiana Code
Title 5. State and Local Administration
Article 10. Public Employee Benefits
Chapter 8. Group Insurance for Public Employees
5-10-8-0.1. Application of Certain Amendments to Chapter
5-10-8-0.3. Use of Certain Accrued Benefits by State Employees
5-10-8-0.4. Legalization of Certain Payments of Deductible Portion of Group Health Insurance
5-10-8-2.2. Public Safety Employees; Surviving Spouses; Dependents
5-10-8-2.7. Insurance of Rostered Volunteers
5-10-8-4. Discrimination as to Form of Insurance Between Certain Employees; Exception
5-10-8-5. Establishment of Common and Unified Plan of Group Insurance
5-10-8-6.5. General Assembly Members and Former Members
5-10-8-6.7. Election of State Employee Health Care Program by School Corporation
5-10-8-7.1. Coverage for Autism Spectrum Disorder
5-10-8-7.3. Early Intervention Services for First Steps Children
5-10-8-7.5. Prostate Specific Antigen Test
5-10-8-7.7. Surgical Treatment for Morbid Obesity
5-10-8-7.8. Colorectal Cancer Testing Coverage; Exception for High Deductible Health Plans
5-10-8-8. Retired Employees; Ability of Employer to Pay Premiums; Eligibility
5-10-8-8.1. Retired Legislators
5-10-8-8.2. Former Legislators
5-10-8-8.3. Former State and Legislative Employees; Health Benefit Plans
5-10-8-8.4. Revocation or Alteration by Employer
5-10-8-8.5. Establishment of Retiree Health Benefit Trust Fund
5-10-8-9. Coverage of Services for Mental Illness
5-10-8-10. Examining Infants for Hiv; Payment
5-10-8-10.5. Dental Care Provisions Required
5-10-8-11. Use of Diagnostic or Procedure Codes
5-10-8-13. Mail Order or Internet Based Pharmacy
5-10-8-14. Coverage for Prosthetic Devices
5-10-8-14.8. Employee Health Plan Providing Coverage for Prescription Eye Drops
5-10-8-14.9. Coverage of Methadone
5-10-8-15. Coverage for Care Related to Cancer Clinical Trials
5-10-8-16. High Breast Density
5-10-8-16.5. Post-Mastectomy Coverage
5-10-8-17. Step Therapy Protocol
5-10-8-18. Prescription Drug Coverage
5-10-8-19. Prior Authorization
5-10-8-21. Coverage for Anatomical Gifts, Transplantation, or Related Health Care Services
5-10-8-22. Coverage for Chronic Pain Management
5-10-8-22.5. Amount Paid for Prescription Drug to Be Counted Against Deductible
5-10-8-23. Reimbursement for Emergency Medical Services
5-10-8-24. Coverage for Pediatric Neuropsychiatric Disorders