Boston Dec 16 Michael Giangregorio's son
Nicholas was diagnosed as severely autistic when he was 18
months old. Now 12, Nicholas requires nearly round-the-clock
care - special schooling as well as speech, occupational and
physical therapy - that can cost tens of thousands of dollars a
It's a formidable expense, but starting in January,
Giangregorio's employer, JPMorgan Chase & Co, will chip
The company announced in late November that it would add
comprehensive autism coverage for expensive intensive therapies
such as Applied Behavioral Analysis (ABA) to its health plan
for 2014. The bank joins about 15 of its Fortune 100 peers,
according to the advocacy group Autism Speaks, which expects
that number to grow.
As many as one in 50 U.S. school-age children - or about 1
million - have a diagnosis of autism, according to a national
survey released by the U.S. Centers for Disease Control and
Prevention last March.
The lifetime costs of treating one person with autism could
top $2.3 million, according to 2012 research from the University
of Pennsylvania and the London School of Economics.
Given the expense, it is no surprise that insurers have had
to be prodded to cover many autism treatments. Thirty-four
states and the District of Columbia now require insurance
carriers to extend coverage for ABA and other autism treatments
in some or all of their individual and small-group policies.
But states don't regulate the self-funded policies offered
by JPMorgan and other large employers, under which about
one-quarter of Americans are covered.
That is changing rapidly. An accelerating number of major
companies have been extending their health plans to include
autism coverage. Companies announcing this year they will add at
least partial benefits include General Motors Co, United
Technologies Corp, Chrysler Group and American
"Adding this type of benefit has been the biggest request
we've heard from employees in recent years, and the outpouring
of gratitude has been overwhelming," says Bernadette Ulissi
Branosky, JPMorgan's head of benefits.
Even with the required co-insurance, Branosky estimates,
most employees who qualify will pay less than $4,000 annually,
compared with amounts that run as high as 20 times that.
INSURERS WARN OF HIGHER PREMIUMS
ABA, a form of highly structured one-on-one coaching by
trained teachers, has become the most widely used autism
treatment in the United States. It is endorsed by the American
Academy of Pediatrics, the U.S. Surgeon General and the American
Many insurers, however, still categorize ABA as an
experimental treatment, because of a lack of long-term research
on its effectiveness, and have largely refused to cover it.
School districts must offer some services for school-age
children, but parents often bear much of the expense.
ABA's very high cost, as much as $60,000 per year per child,
no doubt underlies this reluctance. The Council for Affordable
Health Insurance, a Virginia-based association of health
insurance companies, says that mandating autism coverage could
raise premiums across the board by 1 percent to 3 percent,
according to research it conducted in 2009.
That added expense, the industry group has warned, could
make basic coverage unaffordable for many Americans.
However, data collected from states that require autism
coverage suggests such concerns may be overblown. Two years
after requiring coverage, seven states saw monthly premiums rise
by 31 cents on average per member, according to figures collated
by Autism Speaks. In Arizona's second year of mandated coverage,
autism-related claims totaled about $389,000 - less than 10
percent of the $4,900,000 that the legislature forecast.
Lorri Unumb, vice president for state government affairs at
Autism Speaks, reports similar results in the private sector.
"Companies tell us the additional cost is miniscule, a rounding
error that most don't even pass along to employees," she says.
JPMorgan, which reported $21.3 billion in profits in 2012,
estimates the added benefit for its roughly 200,000 employees in
the United States will cost it around $10 million.
OBAMACARE ADDS LAYER OF COMPLEXITY
Federal law governs self-funded health plans, and advocates
had hoped that Affordable Care Act's 2010 passage would bring
expanded coverage for autism treatment all around. The U.S.
Department of Health and Human Services has suggested a national
standard could come in 2016, but so far the Obama administration
has left it to states to define what the "essential benefits"
are that insurers must provide when it comes to autism.
According to Autism Speaks, only 26 states included ABA
coverage in their benchmark health insurance plans, which
outline the minimum benefits that must be offered on state
To see the current state mandates where you live, go to
Many employers with self-funded plans are moving forward
even without mandates. Several of the country's major technology
companies, including Microsoft Corp and Intel Corp
, led the way more than a decade ago, possibly because
autism - according to California Department of Developmental
Services records - is especially prevalent in Silicon Valley.
The past two years have seen other employers catching up.
Financial services company Capital One Bank is one
of the few employers to pay 100 percent of the cost. Tricare,
the Pentagon's health insurance plan, asks families to
contribute as little as $25 for care regardless of the overall
American Express, in addition to now covering ABA under its
health plan, provides guidance for employees with autistic
children on topics including educational rights, estate planning
and childcare. The company is also in the process of
establishing a special-needs support network, pairing parents of
recently diagnosed children with those have older offspring with
Employer-sponsored benefits apply to children up to the age
26 under the Affordable Care Act. The CDC defines children as
individuals 17 years old and younger.
Giangregorio, for his part, says he is proud JPMorgan has
decided to add coverage for ABA and other autism treatments. In
the past, he says, Nicholas was not able to get the necessary
services he needed, including ABA, due to a lack of insurance.
"Fortunately none of my colleagues with autistic children will
face that now."