The optimal health of all children is best achieved with access to appropriate and comprehensive health care benefits. This policy statement outlines and defines the recommended set of health insurance benefits for children through age 26. The American Academy of Pediatrics developed a set of recommendations concerning preventive care services for children, adolescents, and young adults. These recommendations are compiled in the publication Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, third edition. The Bright Futures recommendations were referenced as a standard for access and design of age-appropriate health insurance benefits for infants, children, adolescents, and young adults in the Patient Protection and Affordable Care Act of 2010 (Pub L No. 114-148). Pediatrics 2012;129:185-189 This policy statement sets forth recommendations for the design of a comprehensive benefit package that covers infants, children, adolescents, and young adults through age 26 and is consistent with the Maternal and Child Health Plan Benefit Model: Evidence-Informed Coverage. 1 These benefit recommendations apply to all public and private health plans. The services outlined in this statement encompass medical care, preventive care, critical care, pediatric surgical care, behavioral health services, and oral health for all children, including those with special health care needs. That payment schedules must cover the fixed and variable costs of providing the services is implied in the identification of services and products necessary to ensure the health of children. In addition, payments should be adequate so that physicians, pediatric service providers, and manufacturers will have continued incentive to remain in (or enter into) the business of caring for the health and developmental needs of children. Because of the variety and complexity of systems for delivering care and for providing payments, a complete discussion is beyond the scope of this statement; however, without adequate payment there is significant risk that children and families will be unable to access services and products needed to maintain and promote health in children. This risk is compounded by the recognition that health in adulthood is predicted by health in childhood. It is critical to stress that adequate payment for the provision of child health care services is a vital investment in life span health. This statement replaces the 2006 statement "Scope of Health Care Benefits for Children from Birth Through Age 21." 2 COMMITTEE ON CHILD HEALTH FINANCING KEY WORDS ancillary services, diagnosis, durable medical equipment, emergency care, health care insurance benefits, hospitalization, preventive services, physician services, prescriptions, therapeutic services ABBREVIATIONS AAP-American Academy of Pediatrics This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any ...

The American Academy of Pediatrics advocates that all children must have health insurance coverage that ensures them access to affordable and comprehensive quality care. Access to care depends on the design and implementation of payment systems that ensure the economic viability of the medical home; support and grow the professional pediatric workforce; promote the adoption and implementation of health information technology; enhance medical education, training, and research; and encourage and reward quality-improvement programs that advance and strengthen the medical home. Health insurance plans must be portable from state to state, with administrative procedures to eliminate breaks and gaps in coverage to ensure continuous coverage from year to year. Plans should ensure free choice of clinicians and foster coordination with public and private communitybased programs for infants, children, and adolescents through the age of 26. The scope of services provided by all health plans must include preventive, acute and chronic illness, behavioral, inpatient, emergency, and home health care. These plans must be affordable and have cost-sharing policies that protect patients and families from financial strain and are without risk of loss of benefits because of plan design, current illness, or preexisting condition. Pediatrics 2010;126:1018-1021

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The purpose of this policy statement is to address the serious underinsurance (ie, insurance that exists but is inadequate) problems affecting insured adolescents' access to needed preventive, reproductive, and behavioral health care. In addition, the statement addresses provider payment problems that disproportionately affect clinicians who care for adolescents.Among adolescents with insurance, particularly private health insurance, coverage of needed services is often inadequate. Benefits are typically limited in scope and amount; certain diagnoses are often excluded; and cost-sharing requirements are often too high. As a result, underinsurance represents a substantial problem among adolescents and adversely affects their health and well-being.In addition to underinsurance problems, payment problems in the form of inadequate payment, uncompensated care for confidential reproductive services, and the failure of insurers to recognize and pay for certain billing and diagnostic codes are widespread among both private and public insurers. Payment problems negatively affect clinicians' ability to offer needed services to adolescents, especially publicly insured adolescents. Pediatrics 2009;123:191-196 INTRODUCTIONHaving health insurance has been associated with better access and utilization of health care, whereas uninsured families are more likely to report experiencing "unmet" health care needs for their children and adolescents. 1,2 In 2006, 13.8% of adolescents 13 through 18 years of age and 28.4% of older adolescents aged 19 through 21 were uninsured. 3 Adolescents at greatest risk of being uninsured are older, are Hispanic, and have low household income. The problems of uninsured adolescents have been a long-standing concern of the American Academy of Pediatrics (AAP) and the subject of several policy statements 4-6 and ongoing state and federal advocacy efforts.Having health insurance that provides comprehensive and affordable coverage for preventive, behavioral, and reproductive care is particularly important for adolescents, because the major causes of morbidity and mortality in this age group are related to injuries from motor vehicle crashes, suicide, interpersonal violence, alcohol and drug use, and risky sexual behaviors. This policy statement presents a series of recommended strategies to address the serious underinsurance and payment problems affecting insured adolescents and the clinicians who care for them.

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