ࡱ > y Z bjbj 4( { { Z x x L # $ N N N N N = = = B# D# D# D# D# D# D# $ % ( P h# = = = = = h# N N }# = N N B# = B# h " N `( S
.! .# # 0 # >! ( ] ( ( " " ( " = = = = = = = h# h# = = = # = = = = ( = = = = = = = = = x : Autism Spectrum Disorder and Early Intervention
(Autism Spectrum Disorder is for Employers with 51 or more Employees)
Covered ServicesYou PayAutism Spectrum Disorder (ASD) For children from age 2 through 6Diagnosis of autism spectrum disorder;
Treatment of autism spectrum disorder;
Behavioral Health Treatment*
Pharmacy Care
Psychiatric Care
Psychological Care
Therapeutic Care**
* Mental Health Services
**Unlimited physical, occupational and speech therapy.
Member cost shares will be dependent on the services rendered. Please refer to the Summary of Benefits.Applied Behavioral Analysis
Limited to a $35,000 per member annual maximum.
20% after applicable deductible if anyEarly Intervention For children from birth through age 3Limited to $5,000 per member annual maximum*
*Unlimited physical, occupational and speech therapyMember cost shares will be dependent on the services rendered. Please refer to the Summary of Benefits.Out-of-Network ServicesUsing Doctors, Hospitals and Other Health Care Professionals not Contracted to Provide BenefitsIf your plan includes out-of-network benefits and you receive covered services from a health care provider outside of our network, the out-of-network deductible and coinsurance applies as outlined in the Summary of Benefits.
Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliated HMO HealthKeepers, Inc. are independent licensees of the Blue Cross Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
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