Autism. Autism means a developmental neurological disorder, usually appearing in the first three years of life, which affects normal brain functions and is manifested by compulsive, ritualistic behavior and severely impaired social interaction and communication skills. This Contract shall provide benefits for the diagnosis of autism in accordance with the conditions, schedule of benefits, limitations as to type and scope of treatment authorized for neurological disorders, exclusions, cost-sharing arrangements and copayment requirements which exist in this contract for neurological disorders. This contract provides for habilitative or rehabilitative services (including applied behavior analysis) and other counseling or therapy services necessary to develop, maintain, and restore the functioning of an individual with ASD who is six years of age or under. There is an annual cap of $30,000 on claims paid for applied behavior analysis for the purpose of treating a person with ASD when applying the benefits required by Georgia House Bill 429. This cap only applies to applied behavior analysis and does not apply to the other treatments (such as counseling or therapy services) which may be required by HB 429. Covered Services are provided for Inpatient care following a mastectomy or lymph node dissection until the completion of an appropriate period of stay as determined by the attending Physician in consultation with the Member. Follow-up visits are also included and may be conducted at home or at the Physician’s office as determined by the attending Physician in consultation with the Member. Additional charges may apply. Mastectomy bras are covered; up to 2 per calendar year. Covered Services are provided following a mastectomy for reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and treatment of physical complications, including lymphedemas Programs require prior authorization and individual case management. One of the Covered Services is for In-Network Spinal Manipulation. There is a limit to the number of visits. Call Customer Service at 800-811-4793 to verify any limitations.
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