Act 62

1. Act 62 What does this mean to me?

2. What is Act 62? Act 62 is the new PA Autism Insurance Act effective as of July 1st, 2009. It requires certain insurance plans to cover a range of services provided to children and adolescents under age 21 on the autism spectrum. Medical Assistance is now the payer of last resort.

3. What is the criteria for my insurance plan to cover services? Criteria Child must be covered under an employer group health insurance policy Child must have an autism spectrum disorder Child must be under the age of 21 Services must be medically necessary and identified within a treatment plan

4. Would anything make my plan not applicable to Act 62? YES Your plan will not pay for the services if it is: a self insured plan an employer that has less than 50 employees a policy that is renewed or issues outside of the state of Pa for a child that does not have an ASD diagnosis a plan that is a chamber of commerce or other association plan a Tricare plan (military plans) MA will pay for services if your plan does not provide coverage

5. What about the 36,000 limit? What does this mean? The 36,000 limit is a dollar amount limit, not a number of visits limit. It is not an extra �bucket� of money for autism services. It is the private insurers dollar amount they are responsible for paying towards the cost of services your child is eligible to receive. Your commercial insurance company will pay for services up to this total amount within an insurance benefit period (based on renewal date). Each time your plan renews, the 36,000 starts over again according to your benefit period, regardless of the renewal date.

6. What if the $36,000 is reached before my benefit period occurs? Your commercial insurance company will send out a notification that the autism benefit is exhausted. At that point, MA will become the payer until your commercial insurance benefit period begins again.

7. My plan has a co-pay and deductible. Am I responsible to pay this? NO. We will bill MA for this. According to the Act, families do not have to pay co-pays, deductibles, or co-insurance amounts as long as families keep their MA current for the provider to bill these amounts to.

8. Family�s Responsibilities

9. How do I update my insurance information with DPW (or any other information that changes)?

10. Does my child still need MA?

11. What commercial insurers does Wesley have a contract with?

12. Who else is Wesley talking with to potentially be in network with?

13. Will Wesley continue to provide services to my child?

14. What if Wesley does not contract with my insurance company?

15. Will the quality of my child�s services be affected in any way because of the Act?

16. Other Frequently Asked Questions

17. Other Frequently Asked Questions

18. Wesley�s contact information for notification of insurance changes, sending copies of your card, etc.

19. Other Resources