Guam § 181103 - Subscription Contracts for Healthcare Insurance;

§ 181103. Subscription Contracts for Healthcare Insurance;

Autism Spectrum Disorder; Coverage; Exceptions.

(a) Except for those offered by a fraternal benefit society,

health care insurance service plans issued by a health insurance

carrier, hospital service corporation, medical service corporation,

insurance company, health maintenance organization, and any

other entity delivering or issuing for delivery in Guam Medicare

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supplement policies or certificates issued pursuant to 22 GCA

Chapter 29 shall not:

(1) exclude or deny coverage for a treatment or

impose dollar limits, deductibles and coinsurance provisions

based solely on the diagnosis of autism spectrum disorder.

For the purposes of this Subsection, “treatment” includes

diagnosis, assessment, and services; or

(2) exclude or deny coverage for medically necessary

behavioral therapy services. To be eligible for coverage,

behavioral therapy services shall be provided or supervised

by a licensed or certified autism spectrum disorder provider.

(b) This Chapter does not:

(1) apply to a health insurance subscription contract

that is issued to an individual or through a small employer;

or

(2) apply to bundled or limited benefit coverage as

defined in § 181101(f) of this Chapter.

(c) The coverage required by this Chapter is subject to all

the terms and conditions of the subscription contract. Nothing in

this Chapter prevents a corporation from imposing deductibles,

coinsurance or other cost sharing in relation to the coverage

required by this Chapter.

(d) Coverage for diagnosis, treatment and behavioral

therapy is subject to:

(1) a Seventy-five Thousand Dollars ($75,000)

maximum benefit per year for an eligible person up to the

age of fifteen (15); or

(2) a Twenty-five Thousand Dollars ($25,000)

maximum benefit per year for an eligible person who is

between the ages of sixteen (16) and twenty-one (21).

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