2015 Autism Applied Behavioral Analysis (ABA) Therapy Benefit

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As announced during the Fall USGHR conference and as approved by the Board of Regents during the September 2014 Board meeting, ABA Therapy will be a covered benefit under the USG 2015 healthcare plans.

1. Limited to children through age 6
2. Members must use a licensed provider or a board certified behavioral analyst to be eligible for benefits under the plan
3. Prior Authorization is required before benefits will be approved

BCBSGA is working to build the network of providers for this benefit. If there is a BCBSGA in-network provider near the member, the member should always select the in-network provider. If the member chooses an out-of-network provider instead of an in-network provider, the benefit coverage will be at the out-of-network benefit level if the member’s plan provides out-of-network coverage (see below Employee Cost Sharing by plan). If the member only has licensed out-of-network providers in their area, then the member may contact Blue Cross Blue Shield of Georgia to see if it is possible to see the licensed out-of-network provider. This is known as a geo-access override.

Kaiser in-network physicians are those working in the TSPMG Developmental Pediatrics Department – Dr. Herbert Singleton and Dr. Mark Moncino.

The Employee Cost Sharing by plan is as follows:

Comprehensive Care Plan – 100% of network rate after $20 co-pay per office visit in network; 60% of network rate out of network, subject to deductible

Consumer Choice – 80% of network rate in-network, subject to deductible; 60% of in-network rate out of network, subject to deductible

BlueChoice HMO – 100% after $30 co-pay per office visit (in-network coverage only); refer to plan benefits for treatment outside of office visit setting i.e. specific speech and physical therapy visits

Kaiser HMO – 100% after $20 co-pay per office visit (in-network coverage only); refer to plan benefits for treatment outside of office visit setting i.e. specific speech or physical therapy visits

If an employee or member has a question about the ABA Therapy benefits or prior authorization requirements, please direct them to call BCBSGA or Kaiser customer service numbers: BCBSGA at 1-800-424-8950, Kaiser Permanente HMO at 404-261-2590

The above benefits coverage information is posted on the USG benefits website on the Healthcare page, http://www.usg.edu/hr/benefits/healthcare.