Kid - check.

Kleenex - check.

Lollipop - check.

Anything else?

Oh yes:Starting Tuesday, many parents will need to bring one more thing with them when they take their child to the doctor's office. Their insurance card.

The North Dakota Department of Health says it can no longer afford to supply free vaccines for all children. Instead, as of the new year, the department will begin billing the insurance companies of children who have coverage. The move is in reaction to what has been, in effect, a decrease in federal reimbursement.

The change affects about 60 percent of the children in North Dakota, but the state's largest insurer said most parents don't have to worry. When the move was announced last fall, Blue Cross Blue Shield said most policy holders will see little or no change. Dr. Jon Rice, spokesman for the Blues, said most plans cover recommended vaccinations, such as those against polio, chicken pox and measles, mumps and rubella.

Even so, the state has urged parents to review their insurance policies so they know what will be covered and what won't after the change.

Molly Sander, immunization program manager for the state health department, said Thursday that some parents could see copayments or different deductibles on their explanation of benefits report for the first time.

"The (biggest) change is that parents should remember to bring their insurance card in with them when they go to their health provider's office," Sander said.

More than 80 percent of infants age 19 to 35 months in North Dakota receive their recommended vaccinations, compared to a nationwide average of 77 percent. The state health department says the number of recommended vaccinations has gone up in recent years, while the federal allotment for North Dakota has not. Newer recommendations from the Centers for Disease Control and Prevention include shots against rotavirus, human papillomavirus and meningococcal virus. No additional money has been given to the states to pay for them, which resulted in the policy shift.

While the change in billing applies to the majority of children and their families, there will be no change for many others. Children who are uninsured, underinsured, eligible for Medicaid or are American Indians will continue to receive free immunizations through Vaccines For Children, a federal entitlement program.

For more information, contact your insurance provider or visit http://www.ndhealth.gov.