Teenagers go through many changes. What should stay the same are the regular visits with their doctor and dentist. Scheduling regular doctor visits, vaccinations, tests, and routine dental exams can help keep them in good health during their teenage years.
Knowing what services your teen’s health plan covers is important. Making sure they are up to date on their shots can help keep them from getting sick.
We are here to guide you and answer any questions you may have about your teen’s plan so they can get the care they need.
Here are a few things to consider for your teenager:
See what medical and dental services your teenager’s plan will cover.
|Benefit type||In-network coverage||What you need to know|
|Primary care provider (PCP)/pediatrician visit||Covered||All EOCCO members have an in-network PCP or clinic assigned to them.|
|Adolescent well-check||One visit per calendar year||It is important to schedule a checkup every year. Your teen's doctor will provide a physical exam and discuss important topics such as physical, social and emotional development, getting caught up on shots, safe sex, healthy eating, exercise, and how to manage stress in a confidential setting.|
|Immunizations (shots)||Covered||A referral is not needed. Your teen's doctor or any network provider can provide these.|
|Emergency room||Covered||An emergency is a condition that puts your teen's life in danger. Call 911 or go to the emergency room when you think your teen is in danger.|
|Urgent care||Covered||Care that your teen needs the same day for serious pain, to keep an injury or illness from getting much worse, or to avoid losing function in part of the body. Your child does not need an appointment.|
|Specialist||Covered||Your teen will need a referral from their doctor before seeing a specialist.|
|Hospital||Covered||Prior approval is needed for in-patient hospital stays. Your teen's doctor will get this approval. The prior approval is not needed in an emergency.|
|Labs, tests, X-rays||Covered||These are covered if your teen's doctor orders them. Other authorized specialists may also order them.|
|STI testing||Covered||Testing for sexually transmitted infections will be covered if your child's doctor or other healthcare provider believes they may be at risk. Your teen may also request these services from their provider.|
|Birth control supplies & education||Covered||Your teen's pediatrician or other health care professional will discuss different birth control options with them. Your teen's plan covers their choice of birth control, including emergency contraception.|
|Pregnancy test||Covered||Pregnancy tests are covered when ordered by a healthcare provider.|
|Exam||Every 12 months||May be covered more often if your teen's doctor or optometrist recommends it.|
|Glasses and contact lenses||Every 12 months||May be covered more often if your teen's doctor or optometrist recommends it.|
|Hearing test||Covered||If your teen is needing hearing services, their doctor will make a referral.|
|Hearing aids||Covered||If your teen is needing hearing services, their doctor will make a referral.|
|Provider visit and mental health assessments||Covered||Your teen can ask for help with depression, anxiety or other mental health services. Services are confidential. No referral is needed when visiting an in-network provider.|
|Wraparound services||Covered||Services that bring together a team of community members and others needed to support parents, families and children.|
|Preventive services||Covered||Exams, cleanings, flouride, varnish, and X-rays. Sealants covered for age 16 and younger.|
|Restorative care||Covered||Treatment for cavities and other problems including: fillings, tooth removal, most crowns, and root canals.|
|Specialist care||Covered||A referral may be needed to see a specialist. Please speak to your teen's dentist before scheduling a specialist appointment.|
|Orthodonia (braces)||Not Covered||Braces are not covered unless to treat cleft palate.|
|Urgent & immediate treatment||Covered||Dental conditions that do not require emergency room care. Examples include: toothache, swollen gums, lost filling.|
|Emergency dental care||Covered||24 hours, 7 days a week. In a dental emergency, call your teen's dentist day or night.|
|Prescription medications||Covered||These are medications that a doctor specialist or other provider prescribes. Your teen can get their prescriptions at any in-network pharmacy. A list of these pharmacies is in the provider directory.|
|Get more pharmacy-related information|
|Weight assessment and counseling in adolescents||Covered||Preventive care|
|Drug and alcohol screening||Covered||Behavioral health|
|Depression screening and follow-up plan||Covered||Behavioral health|
View benefits and coverage for other age groups.
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EOCCO members should have their member ID number ready for quicker help.See more options