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What Treatment is Covered

In many ways, behavioral health coverage is similar to your regular medical coverage. You may receive care from any doctor, hospital or treatment provider you wish only if you are covered in the Premier Plan or MILA Medicare Wrap-Around Plan. Otherwise in the Basic or Core Plan, only services rendered by In-Network providers are covered. As in the Medical Plan, the amount you pay for services and the limits on your coverage depend on whether you receive care from a Cigna In-Network provider or an Out-of-Network provider. Coverage for autism is provided in the Plan, in contrast to other areas of behavior dysfunction that result from organic conditions that are excluded from coverage (for example, organic brain syndrome, Alzheimer’s condition and mental retardation). Coverage for autism will include the following:

  • Medically necessary habilitative therapy (that is, speech therapy, physical therapy and occupational therapy) in the treatment of autism; and
  • Medically necessary treatment of behavioral dysfunction that has resulted from autism including coverage for Autism Spectrum Disorder and for Applied Behavioral Analysis (ABA) Therapy.

The coverage for the treatment of autism will not serve to expand coverage for other conditions such as developmental delays or learning disabilities beyond coverage otherwise available in the Plan.