Definition
Definite diagnosis of autism spectrum disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) published by the American Psychiatric Association (APA).
The diagnosis of autism spectrum disorder must be made by a specialist.
The autism spectrum disorder must be characterized by the following:
a. Persistent deficits in social communication and social interaction across multiple contexts as manifested by at least 1 of the following:
- Deficits in social-emotional reciprocity;
- Deficits in nonverbal communicative behaviours used for social interaction;
- Deficits in developing, maintaining and understanding relationships.
AND
b. Restricted, repetitive patterns of behaviour, interests or activities, as manifested by at least 2 of the following:
- Stereotyped or repetitive motor movements, use of objects or speech;
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behaviour;
- Highly restricted, fixated interests that are abnormal in intensity or focus;
- Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment.
AND
c. Symptoms cause clinically significant impairment in social, occupational or other important areas of current function.
Exclusion
No benefit will be payable under the definition of “autism spectrum disorder” for an insured person whose 3rd birthday occurs prior to the effective date of this coverage.
No benefit will be payable under the definition of “autism spectrum disorder” if the diagnosis is made after the insured person’s 6th birthday.
