Your health plan is available from infant feeding support until your child’s 26th birthday.
Vaccines, exams, kid germs! There’s always something, right? If you’re ever unsure whether your child needs to see a doctor or how urgent a situation is, rest assured that your medical benefit plan offers access to a nurse line. Look at the back of your member ID card and call the number listed. Medical professionals are available 24-hours every day to help you assess the situation and determine if you need care.
Preventive care services are available in all our health plans. Many plans cover these preventive services without cost member, when using in-network providers.
The American Academy of Pediatrics recommends routine exams for immunizations, and screenings beginning at 2 to 5 days of age up to age 21. Many plans cover immunizations recommended by the Center of Disease Control and Preventions (CDC) for newborns and children. Your doctor will review immunizations and discuss any concerns with you.
You can also refer to this handy chart from the CDC. Providers can also evaluate children for sports or school physicals at well-child exams. Sign into your online account and check your benefit booklet to see how your specific plan covers well-child visits.
When your child is ill or showing signs of developmental issues or other concerns, care will be billed as diagnostic, which makes it subject to copay and deductible. A well-child visit is a good time to bring up any concerns about development, reaching growth milestones, stress, sleep, bathroom issues, nutrition, behavioral concerns, or safety, but those conversations are considered diagnostic. Sign into your online account and check your benefit booklet to see how your specific plan covers diagnostic care.
Note your plan’s 24-hour care options, including the nearest in-network urgent care location.
Tooth decay is the most common children’s dental issue, and it’s preventable! Many pediatric dental plans cover fluoride treatments up to age 18. Screening and fluoride treatments can be done at the pediatrician or a dentist.
Basic vision screening at the doctor’s office is covered in the medical benefit plan. If your child needs glasses, vision is included on most plans up to age 19.
Part of a healthy childhood includes reaching emotional milestones, learning healthy social skills, and developing coping skills when things don’t go as planned. Anxiety, behavior, handling emotions, and attention-deficit/hyperactivity disorder (ADHD) are some common reasons children get help.
Trust yourself. You know your child better than anyone else. If something doesn’t feel right, mention it to your child’s provider. Premera doesn’t limit the number of mental health visits covered.
We’re committed to following state law that protects the health privacy of dependents over age 18. At that age, dependents can set up an online member account and receive health communications via email or in their name by U.S. Mail. We also cannot share information about mental, sexual, or reproductive health of dependents over age 18 without their written consent.
Did you know that many states keep copies of your immunization records online? This could come in handy when the school asks for the date of your child’s MMR or if you need proof of immunization for travel. The Centers for Disease Control provides links to state’s immunization information.
Yes, this is usually done as part of the well-child exam. Ask your doctor to sign any forms you need.
Many families get a referral from their pediatrician or through their child’s school. You can also sign into your online account and search for providers in your network. Some therapists have specialties, such as adolescents or LGBT youth. If you’re looking for a specific specialty, a web search can help narrow the list of providers. Our mental health page might also help.
Therapy to help gain functions that were injured or didn’t develop normally, such as speech, occupational, and physical therapy, is included and can be provided in a clinical or home setting.
State law requires us to protect the health privacy of dependents over age 18. That means even if parents pay the plan premium and doctor bills, we are unable to discuss or display sensitive claim information (mental, sexual, or reproductive health) to parents or guardians without consent.
Our members over 18 can sign an Information Release FormGive someone permission to obtain and discuss your personal and health information, including sensitive information such as substance abuse, reproductive health, and mental health. You can also authorize members on your plan to see your sensitive information on Premera.com or ConnectYourCare (medical funding account).
Many options for FDA-approved forms of birth control are included in the drug list without age restrictions. However, not every brand is included. Sign in to your Premera account and go to Prescriptions to see what is covered on your plan.
Some acne medications can be very expensive, but less expensive equivalents are available in the plan drug list. Sign into your account and go to Prescriptions to review your options and compare costs.
Orthodontia isn’t covered on our basic plans. Orthodontia benefits are available on some employer-sponsored plans. Check your benefits booklet for more information. Orthodontia is a qualified medical expense and funds from health savings accounts can be used toward the cost.
Make sure your children still have health coverage when they step out on their own. Most plans allow young adults up to age 26 to stay on a parent’s health plan.
Universities might require a physical exam or vaccines. These can usually be handled at a well-child (or well adult) visit. Common vaccines include the meningitis vaccine. Talk to your doctor about what is appropriate.
Pediatricians generally see kids through college, and sometimes longer if the child has extensive healthcare needs. But Premera benefits do cover providers other than pediatricians if your child is ready to move on.
Benefits under your health plan may differ, so refer to your benefit booklet for information on what your specific health plan covers.
Your health plan covers preventive care services as required by state and federal law. For more information, please review the "A" and "B" rated services on the United States Preventive Task Force, immunizations recommended by the Centers for Disease Control and Prevention and preventive care and screening recommended by the Health Resources and Services Administration. See the list on healthcare.gov.
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Get information on what’s recommended and how it’s covered for all members of the family.