Kids and Health Care: What is Not Covered?

While HMO benefits are generally more comprehensive than those of traditional fee-for-service plans, no health plan will cover every medical expense.

Most plans won't cover eyeglasses or hearing aids because these are considered budgetable expenses (in other words, you should be able to plan for them). Very few cover elective cosmetic surgery, except to correct damage caused by a covered injury.

Some indemnity insurance won't cover checkups or preventive care; and some plans cover complications arising from pregnancy but not normal pregnancy or childbirth.

Both fee-for-service plans and managed care plans limit coverage for experimental procedures -- and they retain the right to define experimental. But recent government regulations have tightened the experimental procedure loophole.

Also, insurers won't pay duplicate benefits. Your children may be covered under health insurance plans that both you and your spouse get at work; but, under what insurance companies call coordination of benefits provisions, the total they can receive under both plans for a covered medical expense can't exceed 100 percent of the UCR fee. And, if neither of your plans covers 100 percent of a procedure, your kids will only be covered for the percentage of coverage (for example, 80 percent) that the more generous plan covers.