Pediatric Services are one of the ten Essential Health Benefits (EHBs) that all non-grandfathered, fully insured small groups (fewer than 50 employees) are required to provide, with the start of plan years that begin on or after January 1, 2014. This is required regardless of whether there are any eligible employees or dependents for these services.
“Pediatric” is defined as under the age of 19.
Pediatric services include dental checkups and vision exams. Medical carriers are the 1st responsible party to include Pediatric Services in their plans. Medical plans offered in the small group market may automatically include pediatric benefits, and may require the group to provide an attestation form for the provision of pediatric benefits as a stand-alone plan, in order to remove the pediatric benefits from the medical plan.
*Some medical carriers will automatically include both Pediatric Dental and Vision in all medical plans. The Pediatric Dental component can be removed as there is a separate charge for these services. Some carriers require a Dental Attestation form to remove this benefit from the plan. The Dental Attestation Form will confirm that the group on behalf of their members have purchased and obtained the pediatric dental essential health benefit through another carrier. Agents will need to submit the attestation form to the managing agent to have the pediatric dental benefit removed from the plan. Pediatric Vision is built into the rates for all Blue Cross and Blue Care Network plans therefore this benefit cannot be removed from the plan even if the group has a stand-alone vision carrier.
Self-funded, grandfathered, and large group plans do not have to offer the pediatric dental benefit.