Well-Child Care

Non-Grandfathered Plans

For HMSA plans that are defined by the Affordable Care Act as “non-grandfathered”, please refer to the Preventive Health Guidelines – Newborns and Children medical policy for the covered services.

• NOTE: In addition to the services identified in the Preventive Health Guidelines – Newborns and Children, the Federal Plan (coverage code 87), HMSA Plan for Postal Service Employees, allows three urinalyses through five years of age rather than one. All other plans cover one urinalysis through five years of age.

Grandfathered Plans

HMSA plans that are defined by the Affordable Care Act as “grandfathered” cover the following services during the period from birth through five years of age (some GF plans cover developmental testing up to age 6):

Note: HMSA plans cover the above-mentioned well-baby visits during a child's first six years according to the following schedule:

• 6 routine well-baby visits during the first 12 months of a child’s life
• 2 visits during the second 12 months
• 1 visit each year for children ages 2, 3, 4 and 5

* The decision for early discharge of mother and newborn is to be made by the attending physician in consultation with the mother. The extra well-baby visit allowed by HMSA when an infant is discharged within 48 hours of birth is intended to provide those services that the infant would have received in the hospital had he or she not been discharged early.

Revision History