Well-Child Benefits

This benefit aims to promote good health and prevention of illness in children. Covered children through age 18 are eligible for this benefit. The State Health Plan covers doctor visits based on recommendations from the American Academy of Pediatrics and immunizations based on recommendations from the Centers for Disease Control and Prevention (CDC) at network providers. 

The Plan pays 100 percent of the allowed amount for approved exams and immunizations. Coverage is available for the following checkups, and the well child care exam must occur after the child’s birthday; however, it does not have to be 365 days from the previous year’s visit. 

  • Younger than 1 year old (up to six visits); 

  • 1 year old (up to three visits); 

  • 2 years old (up to two visits); and 

  • 3 years old until 19 years old (one visit a year). 

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