Plan Features to Evaluate 1. Pediatric Services Covered and Cost-Sharing Requirements Most health plans include a core set of preventive and primary care benefits for children, but differ in the extent to which specialty pediatric services are covered. While most plans apply only nominal co-payments for services delivered by in-plan providers, certain services critical to the care of children may be covered but only available through out-of-network pediatric specialists. Other specialty services may be limited or not covered at all, resulting in a significant added cost to families. It is, therefore, important to examine in- and out-of-plan service coverage and costs together, especially for specialty or chronic care services. The following chart can be used to assess the service coverage and costs to families for each plan being considered.

Pediatric Services Covered	Extent of Coverage	In-Plan Cost Sharing	Out-of-Plan Cost Sharing
Pediatric Preventive Care Services
Well child and adolescent visits, including developmental screening
Immunizations
Vision and hearing
Dental care
Health education
Pediatric Primary and Other Services
Physician services
Hospital services
Emergency services
Surgical care
Prescription medications
Lab and x-ray services
Pediatric Chronic Care Services
Medical subspecialists and surgical specialty services
Occupational, physical, speech, and respiratory therapy services
Mental health and chemical dependency services
Durable medical equipment, supplies and assistive technology devices
Home health care
Nutrition services and products
Care coordination services
Other
Cost-Sharing Provisions and Catastrophic Protections
	Amount
Annual premium
Annual deductible
Annual out-of-pocket cost limit
Lifetime out-of-pocket cost limit

Index | Introduction Pediatric Services Covered and Cost-Sharing Requirements Pediatric Provider Network Capacity Evaluating Quality Management