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 COL6/24/2021 CH. 18 THE CONTRACT OF INSURANCE 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). COL6/24/2021 CH. 18 THE CONTRACT OF INSURANCE