Now that you have health insurance, you may be wondering what’s covered and what’s not for your dependent child(ren).
By law (namely, the Affordable Care Act — ACA), certain preventive services for children through age 18 must be covered at 100%. This means no copayment, no coinsurance charge, and regardless of whether or not you have met your annual deductible.
Your child must receive these services from an in-network provider for your plan to cover 100% of the charge.
Preventive Services for Children
Here is a list of the preventive services that must be covered for children ages 18 and under:
| TYPE OF SERVICE | DETAILS |
|---|---|
| Alcohol and Drug Use Assessment | For adolescents ages 11-18. |
| Autism Screening | At ages 18 months and 24 months |
| Behavioral Assessments | At ages 0-11 months, 1-4 years, 5-10 years, 11-14 years, 15-17 years |
| Blood Pressure Screening | For children at recommended ages: 0-11 months, 1-4 years, 5-10 years, 11-14 years, 15-17 years |
| Congenital Hypothyroidism Screening | Once at birth |
| Cervical Dysplasia Screening | For sexually active females |
| Depression Screening | For adolescents |
| Developmental Screening | For children under age 3; continued monitoring throughout childhood |
| Dyslipidemia Screening | For children at higher risk for lipid disorders at ages 1-4 years, 5-10 years, 11-14 years, 15-17 years |
| Fluoride Supplements | For children without fluoride in their water source |
| Gonorrhea Preventive Medication | For all newborns, once at birth |
| Hearing Screening | For all newborns |
| Height, Weight, Body Mass Index | For children at ages 0-11 months, 1-4 years, 5-10 years, 11-14 years, 15-17 years |
| Hematocrit or Hemoglobin Screening | For children |
| HIV Screening | For adolescents at higher risk |
| Immunizations | As recommended (see below) |
| Iron Supplements | For children ages 6-12 months at risk for iron deficiency (anemia) |
| Lead Screening | For children at risk of exposure |
| Medical History | For all children throughout development |
| Obesity Screening and Counseling | For all children |
| Oral Health Risk Assessment | For young children at ages 0-11 months, 1-4 years, 5-10 years |
| Phenylketonuria (PKU) Screening | For newborns |
| Sexually Transmitted Infection (STI) Prevention Counseling and Screening | For adolescents at higher risk |
| Tuberculosis (TB) Testing | For all children at higher risk |
| Vision Screening | For all children |
Note: Some grandfathered plans are not required to cover all services.
Immunizations for Children
Here are the covered immunizations for children up to age 18. These are covered at 100%, with no copayment, no coinsurance charge, and regardless of whether or not you have met your deductible. The immunization must be given by an in-network provider to be covered at 100%
| IMMUNIZATIONS – VACCINES FOR CHILDREN AT RECOMMENDED AGES |
|---|
| Diphtheria, Tetanus, Pertussis/Whooping Cough (DTP) |
| Haemophilus Influenza Type B |
| Hepatitis A |
| Hepatitis B |
| Human Papillomavirus (HPV) |
| Influenza (Flu Shot) |
| Measles, Mumps, Rubella (MMR) |
| Meningococcal (Meningitis) |
| Pneumococcal |
| Polio (Inactivated Poliovirus) |
| Rotavirus |
| Varicella (Chicken Pox) |
Note: Some grandfathered plans are not required to cover all services.
Check Your Policy Information
For more detailed information, check the documentation you received with your policy. Be sure you understand what your plan covers before you seek medical treatment, so there are no surprises later!
Give our office a call or send us an email if we can answer any questions for you.
Click here for a list of preventive services and immunizations covered for adults.
Click here for a list of preventive services covered for women.
