PEDIATRIC BENEFITS Clause Samples
The Pediatric Benefits clause defines the scope and extent of healthcare coverage provided for children under a health insurance policy. Typically, this clause outlines which pediatric services are included, such as routine check-ups, immunizations, and treatment for childhood illnesses, and may specify age limits or eligibility criteria for dependents. Its core practical function is to ensure that policyholders understand what medical care is available for their children, thereby promoting access to essential pediatric healthcare and reducing uncertainty about covered services.
PEDIATRIC BENEFITS. The dental benefits described in this Section are available only for Members under 21 years old. Members that were under 21 years old when they enrolled in this Contract, and during the Policy Year attain age 21, will continue to be covered under this Section until the end of that Policy Year. Diagnostic and Preventive Services Sealants
PEDIATRIC BENEFITS. The dental benefits described in this Section are available only for Members under 21 years old. Members that were under 21 years old when they enrolled in this Benefit Plan, and during the Policy Year attain age 21, will continue to be covered under this Section until the end of that Policy Year. If there is only one Child Member, the Out of Pocket (OOP) Yearly Maximum per Child Member will apply, which is the maximum dollar amount that the Child Member will have to pay out of his/her own pocket during a Policy Year. Once the Child Member pays the maximum OOP in deductible and coinsurance for covered Benefits, the Member’s Benefits will be 100% covered until the end of the Policy Year. To the contrary, if there are two or more Child Members covered under this Benefit Plan, the Out of Pocket (OOP) Yearly Maximum per 2 or more Child Members will apply. Once that maximum OOP amount is paid in deductible and coinsurance for covered Benefits by any Child Member, all the Child Members will be 100% covered until the end of the Policy Year.
A. Diagnostic and Preventive Services