age of pediatric vaccines (as defined under [the Medicaid program]) below the coverage…provided as of May 1, 1993."4 Thus, employers that provided any vaccine coverage as of that date must continue to provide such coverage. This “maintenance-of-effort” provision was aimed at preventing employer-sponsored plans from reducing coverage following enactment of the VFC program. While the statute does not require a particular level of coverage and does not specify standards regarding deductibles and cost sharing, it establishes some federal standards with respect to childhood immunizations.5

There are few data available on insurance practices with respect to immunizations. One national survey of employer-sponsored health coverage reports that coverage of childhood immunizations is common, but it does not provide detailed information about the nature of the coverage, e.g., whether it meets the ACIP standard or whether deductibles and copayments apply (KPMG Peat Marwick, 1998) (see Table 3–2). The results of this survey support an estimate that 92 percent of all children covered by employer-sponsored plans, or 42 million children, have some coverage for immunizations.6

Researchers at The George Washington University collected data on the immunization coverage policies of five health care companies (four national and one regional) that suggest significant variation by type of plan, as well as by vaccine (S.Rosenbaum, The George Washington University, personal communication, February 8, 2000). Consistent with the KPMG study, the respondents indicated that coverage varies by type of product. All five companies reported that they generally would cover

TABLE 3–2 Coverage of Pediatric Immunizations by Health Benefit Plans Offered by Employersa

Type of Insurance Product

Percentage of Covered Workers with Each Type of Productb

Percentage of Employees with Dependent Coverage for Pediatric Immunization Servicesc

Health Maintenance Organizations

28

99

Point-of-Service Plans

25

98

Fee-for-Service Plans

9

79

Preferred Provider Organization Plans

38

86

aInsurance coverage does not mean that children actually get vaccinated.

bSOURCE: Health Research and Educational Trust, 1999.

cSOURCE: KPMG Peat Marwick, 1998.



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