Reviewing Your Family’s Health Insurance Coverage: Questions to Ask

The questions below can help in your plan review, with special consideration for your children’s care.

• Do I have to get a referral from my child’s primary care pediatrician or employee assistance program to receive specialty pediatric services, such as ADHD?
• Are there limits defined by the insurance plan as to what I can have my primary care pediatrician treat?
• Is there a preferred list of providers or network that I must see? What happens if I want my child to be seen by someone outside of the network?
• Is my current pediatrician on the preferred list of providers? Are the pediatric specialists that my pediatrician prefers to make referrals to on the list of network members?
• Are there limits on the number of visits?
• What are the copayments and deductibles that I must pay under my plan?

Additional Resources

• Things to Consider When Evaluating Health Insurance Plans
• FAQs: Preferred and Out-of-Network Providers
• Exclusions and Limitations: Reading the Fine Print
• Pediatric Specialists: Coverage Information
• Primary Care Coverage: Information for Parents
• Services Requiring Prior Approval
• Understanding Cost Sharing: Deductibles, Copayments & Coinsurance