All infants, children, and adolescent patients through age 21 years must have access to comprehensive health care benefits that will ensure their optimal health and well-being. The following services should be included in the health benefit plans offered by all private and public insurers. These services should be performed in a cost-effective manner that does not compromise the highest quality of care in a variety of appropriate settings. As these services are physician directed and medically necessary, they should not be limited and should include all of the following:
1. Medical care, including (a) health supervision with its preventive care and immunizations according to the "Recommendations for Preventive Pediatric Health Care"1 of the American Academy of Pediatrics, and, (b) diagnosis and treatment of acute and chronic illness, developmental disabilities, learning disorders, and behavioral problems.
2. Surgical care.
3. Mental health services including those appropriate for treatment of substance abuse and other psychosocial problems, as directed or prescribed by a physician.
4. Emergency and trauma care services.
5. Inpatient hospital services.
6. Specialty and pediatric subspecialty consultations occurring either in the inpatient or outpatient setting.
7. Family planning services.
8. Pregnancy services including: (a) genetic counseling and related services as needed; (b) prenatal care; (c) prenatal consultation with a pediatrician; (d) care of all complications; (e) counseling on all pregnancy options; (f) elective termination of pregnancy; (g) care for the pregnancy of a single dependent of the policy holder.
9. Care of all newborns and infants including: (a) Attendance and management at high-risk deliveries; (b) health supervision; (c) treatment of congenital anomalies and other illnesses on injuries.
- Copyright © 1993 by the American Academy of Pediatrics