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Background: Most insurance coverage in the US has separate policies and payroll withholding for health, dental, and vision insurance plans. One can typically decide who's covered independently for these plans (or pick and choose these plans from one spouse's employer to the other's). Coverage is usually either employee, employee+spouse, or employee+family (spouse and children).

One can also typically change these things after a life event (birth of a child, marriage, etc.) or annually during the enrollment period.

Question: My wife and I had a daughter last month. We're obviously enrolling her on our health plan immediately. She doesn't yet have teeth and is too young for any vision correction (or even to know whether she'll need any), so it doesn't seem to make sense to include her on the dental or vision plans yet. At what point would it typically make sense to do so? Is there any compelling reason why she should be included on the plans now? We'd just be paying the higher family withholding without being able to take advantage of any of the services, right?

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You might want to check when your plans actually cover children, some have restrictions and this may definitely influence your decision. –  MichaelF Aug 25 '11 at 15:58
    
Some pediatric dentists want to see your child as young as 1 year to check their gums/whatever teeth they may have. Additionally, your ped will start checking your daughter's visual development at appointments and could discover problems that require more in-depth analysis. My daughter had her cataracts removed when she was 10 and 14 weeks old and has worn contact lenses ever since (she's 2 now). Granted, congenital cataracts are a relatively uncommon eye problem, but you would be amazed at the number of very small children I've seen at out ped Ophthalmalogist's office wearing glasses –  Meg Coates Sep 4 '12 at 14:19
    
for other eye conditions not immediately detectable at birth. –  Meg Coates Sep 4 '12 at 14:22
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5 Answers

Basically, enroll them slightly before their services are needed.

You're right: There's no reason for her to have dental/vision coverage now when there's no way for it to be used.

However, some plans have "vesting" times, where the individual must be covered for a particular length of time before being eligible for coverage by some portions of the plan. (e.g. Must be covered for 2 years before eligible to have braces or dental surgery covered.) Find out what these are, decide what your children are likely to need and enroll appropriately.

As HedgeMage so wisely noted: What is "medically needed" and what is "needed to do X" may be 2 different things. Some schools or organizations that you'd like to enroll your child into may require tests or screenings beyond common guidelines.

Finally, be mindful of those enrollment windows and don't miss them. If you or your wife are at all forgetful in any way, the peace of mind might be worth the incremental cost. I have a memory like a sieve -- getting it all in at once, even if the services were of no use at the time, would be better for me than forgetting to enroll them and have to pay out of pocket for services for a year (or possibly more, if anything other than routine visits were required and not covered).

Addendum: If you have access to a Flexible Spending Account (FSA) at your workplace, enroll if you haven't already. You'll be going to the doctors quite a few times for the first few years for both well-baby and sick-baby vists, and if you have co-pays on visits and prescriptions, they can be quite a chunk of change.

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Agreed, but I'd like to add that "needed" isn't necessarily "needed" in the medical sense. Depending on what kind of child care / preschool / etc. you enroll him/her in some day, they will require tests/evaluations/etc. that may not be medically necessary. For example, when I lived in IL state law required dental X-rays and exams from all kindergarten students, and many preschools started requiring them as well, regardless of whether there was a real reason to do X-rays. It can be a hefty bill without insurance. –  HedgeMage Aug 15 '11 at 18:43
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It depends. Normally, you wouldn't need to take a young child to the dentist until they are at least 3 or 4, unless there are higher than normal risk factors for dental health. However, my son managed to chip a tooth at 13 mo. so we had to take him into a dentist to get his tooth filed, and had to pay for it out of pocket because we didn't have coverage for him yet.

So weigh the risk of having out of pocket expenses against the cost of unnecessary coverage.

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This question can quickly lead to a rant about how shoddy our US health care system is. Why our society deems dental separate from the rest of our body's well-being is beyond me. But I'll save that rant for another day. ;)

As a parent, my advice would be to get them into a dental plan ASAP. For the first several years, you won't need the high-end plan...but you do want to get them going to the dentist regularly for a variety of reasons. First, it gets them used to going to a dentist...which is a good habit. Secondly, even with baby teeth, they can have issues--both with the first set of teeth as well as being an indicator of what's to come.

As for vision--sadly, that's more of a scam than anything. Well, 'scam' may be a bit harsh, but it's a bit of a racket. The retail eyeglass industry has massive profit margins. Most vision plans are merely ways to get you to pay for annual eyeglasses rather than any sort of major medical eye coverage. These days, you can do most of your eyeglass shopping online. http://glassyeyes.blogspot.com/ is a web site that has been talking about all the various options for getting your glasses online and have bee mostly impressed by what you can do online. You'd still need to get your child a appointment with a local optometrist, but those can be had for under $100. And with eyeglasses being sold online for $30, that's a lot cheaper than forking out for the annual vision plan in most instances.

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I would add that if you may be able to find an eye doctor who bills under medical (insurance). I don't think optometrists will do this but many doctors are have an MD in ophthalmology will. This way you can even get the exam and just pay a medical doctor visit copay (though they may do eye tests that are not covered under medical insurance but might have been if it was vision). –  auujay Aug 26 '11 at 18:19
    
I would disagree about the vision insurance being a racket, but I suppose it depends on the insurance you have. If you child doesn't require glasses until they're older then I guess maybe, but our vision insurance has paid for many many pairs of contact lenses for our daughter or paid for a significant portion of replacement lenses, and we can't just order these lenses online--they have to be specially ordered. –  Meg Coates Sep 4 '12 at 14:30
    
@Meg if the prescription is complex, I'd agree. And, in fact, the more I think about it, for children, having a local fitting and trying on of lenses is probably a good idea. But for teenagers or adults that fall into the 'common range' of prescriptions, you'd be surprised at how affordable the online options are. I now get my prescription glasses and sunglasses for about $50 a pair. –  DA01 Sep 4 '12 at 15:31
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@DA01: I absolutely agree. If you're dealing with adults and teenagers you may as well do some searching and get the best deal possible. But since the OP is specifically asking about a very young child, I can tell you that eye troubles that arise at that age are going to be more complex in nature and require seeing a specialist. Plus their staff is trained in fitting and handling very small children, and, as a parent, it helps immensely to have their support! –  Meg Coates Sep 5 '12 at 13:50
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I asked my dentist, he said bring them in at 4 for a ride in the dentist chair and a quick fake checkup - it makes it fun. Then follow his/her advice for the next appointment.

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Our child had vision problems detected at his 3½ year checkup, and it turns out his eyesight is terrible (we had no idea). Online eyeglass stores were a boon for this, as small children absolutely destroy - willfully and otherwise - spectacles, and $50/pair is much less painful that $350/pair. His prescription has changed once in the 18 months since first visiting the optometrist, but the visits have been approximately monthly.

Both he and his brother had have dental work; because of their young age the surgery required hospitalization. Our normal dentist didn't detect these problems; it was only the pediatric dentist that was sufficiently expert to notice them.

I can imagine that our specific experiences would have been quite costly in the USA.

Purely on my own experience I suggest that prior to three years of age you're not going to detect any inherent problems with your child's teeth or eyes.

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