Childhood Obesity Benefit – Your Questions Answered

My child was diagnosed as obese last year, is he/she eligible for this new benefit?
Yes. If a member is between the ages of 6-18 and under a non-grandfathered policy, full coverage for the intensive comprehensive treatment begins based on a diagnosis in 2016 and is effective for six months after diagnosis. After the six-month period, coverage will move to contract benefits. Treatment must be provided using an in-network provider.

My child was diagnosed as obese in January and I did not schedule an appointment with a registered dietitian for a couple of months. Does my six months of coverage start once that appointment for treatment is scheduled?
No. The six months of full coverage begins at the diagnosis of obesity during a primary care doctor (or pediatrician) visit. Treatment must be provided using an in-network provider and for a child between the ages of 6-18. After the six-month period, coverage moves to contract benefits.

Is the six months of full coverage available annually?
No. This is a once in a lifetime benefit.

If I change my medical policy that also includes this benefit, does my child’s coverage start over?
No. This is a once in a lifetime benefit.

My child is overweight. What resources does Blue Cross have that can help me?
If your child is under a non-grandfathered policy, the child has access to at least four primary care doctor (or pediatrician) visits and four registered dietitian visits as part of the healthier generation benefit. To find a primary care doctor, pediatrician or registered dietitian in your child’s network, visit the provider directory, enter your zip code and select the preferred provider.

If your child is under a grandfathered, fully insured policy, registered dietitian visits are covered as contract benefits.

If my child turns 19 during the six-month treatment, will he/she be able to complete the treatment?
If a member is 18 and turns 19 during treatment, those claims filed after his or her 19th birthday will pay at contract benefits.

How can I find out what kind of policy I have?
Contact the customer service number on the back of your member ID card.