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Children’s Health Care in Members’ Plans: 3 Things Trustees Should Know

By Jennifer S. Kiesewetter, Esq. | Jan 22, 2018

The number of uninsured children in the United States is currently at an all-time low, with only 5 percent uninsured, according to the Kaiser Family Foundation. Children's health care, however, is comprised of a complex web of federal, state and local laws and regulations, as reported by The Brookings Institution. A uniform approach to comprehensive pediatric health care is not currently on the table, although more children have access to coverage than adults.

Trustees can design their funds, however, to improve their offerings of children's health care benefits. Here are three things that trustees should know about improving benefits and utilization of pediatric health care for members.

Coverage Based on Needs

According to the Kaiser Family Foundation, employer-sponsored group health plans covered approximately 53 percent of children in 2015. However, funds can differ greatly from organization to organization. Trustees should aim to design funds around the needs of children and their families, as opposed to just providing the minimum-required benefits included in the policies presented.

For example, according to The Brookings Institution, for children over one year old, injury is the leading cause of death. Knowing this, trustees can improve their benefits for injuries — from hospitalization to physical therapy to domestic abuse.

Expanding Mental Health Coverage

According to the National Alliance on Mental Illness (NAMI), mental health is a significant health care dilemma in the United States. The significance of mental health among children and teenagers is no different, with 50 percent of lifetime mental illness cases beginning by age 14 and 75 percent beginning by age 24, as reported by NAMI. Additionally, NAMI states that the average time between a child's onset of mental illness and intervention is 8 to 10 years.

This gap from onset to intervention is critical because during the intervening time, children can experience problems in school, with family or elsewhere. This can result in violence and even suicide, which "has become a major cause of death among adolescents," according to The Brookings Institution.

This clearly puts tremendous stress on families. Trustees can help ease this stress by expanding mental health benefits in their trusts, from behavioral interventions to rehabilitation to counseling. Including access to mental health specialists — beyond the pediatrician — provides an additional layer of access and services to children for early detection, intervention and treatment.

Preventive Care (and Awareness)

Under the Affordable Care Act, private group insurance is required to provide certain preventive services without co-pays, including 26 services for children, as reported by Kaiser Family Foundation. Some of these services are routine immunizations, wellness visits for babies and screening for genetic disorders.

The Kaiser Family Foundation reports that although the number of individuals gaining access through preventive services is large, public knowledge of these services is low. Of course, awareness is key. Trustees should educate their members on the services already existing in their funds. This is an excellent way to increase utilization of services and perhaps ward off more serious illnesses and conditions by catching them early.

By responding to the needs of children and their families, and encouraging members to utilize their preventive care, trustees can take significant steps toward improving their children's health care offerings for their members.

Jennifer Kiesewetter, founding and managing member of Kiesewetter Law Firm in Memphis, Tennessee, is a seasoned attorney in the field of employee benefits. Ms. Kiesewetter's practice includes regulatory compliance and governance with the Employee Retirement Income Security Act of 1974 (ERISA), the Internal Revenue Code and the Affordable Care Act (ACA), in addition to the other federal laws governing employee benefits and health care compliance regulatory law. She's also an Adjunct Professor of Employee Benefits at University of Memphis Cecil C. Humphreys School of Law. Additionally, Ms. Kiesewetter is a frequent writer and speaker on the topic of employee benefits and health care compliance regulatory law, locally, regionally and nationally.


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