Health Insurance Coverage

PA Autism Insurance Act (Act 62)

The document covered here is the PA Autism Insurance Act (Act 62).

You may download a PDF of the original document HERE.

In Brief, the Document States:

An insurance company is not permitted to treat someone on the autism spectrum any differently than they treat any other person that they cover.

In Greater Detail, the Document States:

This notice to the insurance companies defines acceptable exclusions or limitations of the insurance coverage for autism spectrum disorders. The law requires coverage of diagnostic assessment and treatment of autism spectrum disorders by certain insurance companies or contracts.

This insurance act requires coverage for autism spectrum disorders which includes, medical, psychological, and rehabilitative care. Even if these specific treatments are excluded from the person’s insurance policy, the insurance company must still cover these treatments for a person on the autism spectrum if they are deemed medically necessary and prescribed.

There are types of treatments not covered under the law. If an insurance company does not cover specific treatments such as acupuncture for any insured person, the company is not required to provide this coverage for treatment for autism spectrum disorders.

The insurance company may limit the amount of coverage that they provide so long as it is the same limitation for every person that they cover. If a policy requires services be provided by a participating provider, then this requirement also applies to those on the autism spectrum.

Questions Regarding This Notice May Be Addressed To:

Shelley D. Bain, J. D.
Director, Bureau of Accident & Health Insurance
Insurance Department, 13th Floor
Strawberry Square, Harrisburg, PA  17120
ra-in-autism@pa.gov

Further Resources

View the DPW’s web site on the PA Autism Insurance Act (Act 62). The Department of Public Welfare, the Pennsylvania Insurance Department, and the Department of State are working together to implement the PA Autism Insurance Act.

Act 62 Statute – House Bill 1150 was signed into law on July 9, 2008 and became Act 62. View the bill and its history here. The portion of the bill that deals with autism insurance begins on page 5, line 17.

View information about issues such as coverage, requirements, and treatments in the Autism Insurance Fact Sheet.

View the letter sent to Pennsylvania families about Act 62, and find out if the Autism Insurance Act applies to your child.

View the Frequently Asked Questions and Answers About the Autism Insurance Act. Subjects include general issues, covered services, private insurance, qualified providers, and licensing.

View the Act 62 Quick Facts, provided by the PA Health Law Project.

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