Choosing Your Child's Health Insurance Plan
by the experts at The Children's Hospital - Denver

Children Have Special Healthcare Needs · Children are not small adults. · Anatomically, children are different and therefore they have different healthcare needs from those of adults. · Compared to adults, children suffer from more acute than chronic conditions. · Children go through rapid changes physically, functionally, socially, emotionally and intellectually as they grow. · Children's organs, bones and immunologic systems all go through different developmental stages before reaching maturity. · Due to a limited ability to communicate, diagnosing and treating some illnesses in children may be more difficult and time consuming. · Children require greater emotional support in coping with an illness.

Choosing a health insurance plan can be one of the most important decisions you make for your family. Many people choose a plan based on cost. Others look for plans that have doctors and hospitals close to where they live. But as a parent, you now have a lot more to consider. Does the plan have adequate coverage for my children? What are the services covered by the plan? What doctors and hospitals can I use? Children have very special healthcare needs. You should be very careful in your selection. Make sure your health plan provides comprehensive health-care coverage for children.

Services To Look For
A comprehensive health plan for children should include the services listed below. Some plans do not cover all of these services. This is another reason why it is important to compare plans carefully.

Preventive and Primary Care
• immunizations
• routine check-ups (the American Academy of Pediatrics recommends that children have at least 22 routine check-ups from birth through adolescence)
• doctor visits for sick children
• speech, hearing and vision tests
• dental check-ups
• health education
• prescription drugs
• laboratory and X-ray services
• family planning
• pregnancy and childbirth services

Major Medical Care
• consultation with doctors who specialize in treating children
• hospital services in a Children's Hospital if needed
• diagnostic services by those who specialize in treating children
• ambulance services

Special Care
• long-term care for chronic conditions
• counseling services
• physical, speech, occupational and other types of developmental and rehabilitation therapies for children

Comparing Health Insurance Plans
Now that you have a greater understanding of your children's unique healthcare needs and the services included in a comprehensive health plan, you are better prepared to evaluate your health plan options.

You should compare health plans by finding out:
• What services ARE covered?
• What services ARE NOT covered?
• Are there limits on the services, such as prenatal visits and well-baby check-ups?
• Are there limits on the length of time I can use a service, such as physical therapy or home health care?
• What are my out-of-pocket expenses, such as co-payments, deductibles, monthly premiums?

Make a list of the services your child needs. Ask your doctor what healthcare services your child needs now or may need in the future. Compare these with the services that the plan covers. Also, it is important to think about the unexpected. If an emergency comes up, you will want to have the security of knowing that the care your child needs is there and will be covered.

How Your Doctor Can Help
Your doctor is an excellent resource in helping you to choose a health plan. Some questions you can ask your doctor are:

• Do you participate in any of the plans I am considering purchasing?
• What do you think about their benefits and services?
• Do you know if the other physicians you refer your patients to participate in these plans? Do you need the plan's approval to refer to these physicians and how long can this take?
• Is it easy for you to refer your patients to a Children's Hospital when needed?

How Family and Friends Can Help
Family, friends and co-workers are also good resources in helping you choose your child's health care plan. You should ask them:

• What health care plan do you have?
• Why did you choose this plan?
• Are you satisfied with your choice?
• What do you like best about the plan? What do you like least?
• Did you ever have a bad experience getting services your child needed approved by your plan?
• Have you been able to get special services approved when needed?
• Have you had any difficulty getting claims paid?

Unfortunately, the results of your plan comparison may be disappointing. You may realize that none of your choices provide adequate coverage for children. One plan may provide good coverage for routine care, but restrict or limit services, such as prescription drugs or home health care. Other plans may offer overall good coverage but limit your access to specialty services for children. If you obtain your health insurance through an employer, find out who is responsible for deciding which plans to purchase and make this person aware of your concerns. This information might prompt your employer to consider other options in the future when choosing health insurance. You are a valuable asset to your employer. They don't want you to have to worry that your child's health care needs may not be adequately covered by your health insurance plan.

Editorial provided by the experts at The Children's Hospital in Denver, Colorado.