EOCCO preventive services for teens 13-16 years old

Keep your teenager on a healthy track

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:

  • Choose a pediatric doctor and dentist. Choosing and keeping a relationship with their doctor and dentist is important for their overall health and development during their early teen years.
  • • Schedule regular physical exams. These visits may include talking to their doctor about important topics such as physical, social and emotional development, getting caught up on their shots, reproductive health and healthy relationships, exercise and eating right.
  • Schedule dental visits. Regular dental checkups are also good for your teen’s overall health. These visits may include a cleaning, sealants, fluoride and X-rays.

What does your teen’s health plan cover?

See what medical and dental services your teenager’s plan will cover.

Benefit type In-network coverage What you need to know
Medical
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.
Reproductive health
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.
Vision
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
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.
Behavioral health
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.
Dental
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.
Pharmacy
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
Screenings
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

 

Coverage by age

View benefits and coverage for other age groups.

Questions?

Customer Service: 888-788-9821 (TTY users: 711)
Hours: Monday through Friday, 7:30 a.m. to 5:30 p.m. PST

EOCCO members should have their member ID number ready for quicker help.

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