EOCCO preventive services for 17 and 18 year olds

Your next chapter in healthcare starts with you

You will soon turn 18. As a young adult, you will be in charge of your healthcare. This means it will be up to you to schedule your regular doctor visits, vaccinations, tests, and routine dental exams to maintain good health.

As you step into this new chapter in your life, we are here to guide you and answer any questions you may have about your health plan and getting the care you need.

Here are a few things to consider when you turn 18:

  • Choose your doctor and dentist. If you do not currently have a primary care provider (PCP) and dentist, please contact customer service for help choosing one.
  • Schedule a physical exam with your new PCP.This visit may include talking to your doctor about important topics such as exercise, stress, eating right, getting caught up on your shots, reproductive health and healthy relationships, in a private setting.
  • Schedule a dental checkup with your dentist. This may include a cleaning, sealants, fluoride and X-rays.
  • Get a referral from your PCP. This is required before seeing a specialist for:
    • Physical therapy
    • ENT (ear, nose, throat doctor)
    • Dermatology (skin doctor)

What does your 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 Once you turn 18 you may transition from seeing a pediatrician to seeing a family physician or other PCP. Your PCP should be your first call when you need care. Call your PCP to make an appointment.
Adolescent well-check One visit per calendar year It is important to schedule a checkup every year. Your doctor will provide a physical exam and discuss important topics such as healthy eating, exercise, getting caught up on shots, safe sex and how to manage stress in a confidential setting.
Immunizations (shots) Covered A referral is not needed. Your doctor or any network provider can provide these.
Emergency room Covered An emergency is a condition that puts your life in danger. It can be an injury or a sudden illness. The emergency can also cause harm to your body. (broken bones, bleeding that does not stop, loss of consciousness, seizure, severe pain…). Call 911 or go to the emergency room when you think you are in danger.
Urgent care Covered Care that you need the same day for serious pain, to keep an injury or illness from getting much worse, or to avoid losing function in part of your body. You do not need an appointment. (infections, sprains, strong pain…)
Specialist Covered You will need a referral from your doctor before seeing a specialist.
Hospital Covered Prior approval is needed for in-patient hospital stays. Your doctor will get this approval. The prior approval is not needed in an emergency.
Labs, tests, X-ray Covered These are covered if your 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 PCP or other healthcare provider believes you may be at risk. You may also request these services from your provider.
Birth control supplies and education Covered Your doctor or other health care professional will discuss your different birth control options with you. Your plan covers your choice of birth control, including emergency contraception. These services are confidential and do not require parental consent.
Pregnancy test Covered Pregnancy tests are covered when ordered by a healthcare provider. Test and results are confidential.
Vision
Exam Covered For members under age 21
Glasses/contact lenses Covered For members under age 21
Hearing
Hearing test Covered If you are needing hearing services, your doctor will make a referral
Hearing aids Covered If you are needing hearing services, your doctor will make a referral
Behavioral health
Provider visit & mental health assessments Covered You 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 require planning with your school, community organizations, medical providers, criminal justic system and others needed to support you.
Emergency services Covered Emergency behavioral health services do not need preapproval. Call 911 or go to the emergency room if you are in danger.
Dental
Preventive services Covered Routine preventive services include: routine cleaning, sealants, flouride, varnish, xray.
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 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. Excamples include: toothache, swollen gums, lost filling
Emergency dental care Covered 24 hours, 7 days a week. In a dental emergency, call your dentist day or night. Examples include: a tooth that has been knocked out, severe swelling or infection in the mouth, severe tooth pain. Emergency dental care does not usually require a trip to the Emergency Room. Emergency dental care should be handled by your dentist or by the on-call dentist.
Pharmacy
Prescription medications Covered These are medications that a PCP, specialist or other provider prescribes. You can get your prescriptions at any in-network pharmacy. A list of these pharmacies is in the provider directory.
Get more pharmacy-related information

 

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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