EOCCO preventive services for 17 and 18 year olds

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
Outpatient Mental health assessments, group therapy and therapy	Covered	Your child can access help for any mental health services. No referral is needed.
Wraparound services	Covered	Services that bring together a team of community members and others needed to support parents, families and children.
Intensive care coordination	Covered	You can refer yourself for care coordination services, or someone can refer you. No referral or preapproval required.
Early Assessment & Support Alliance (EASA	Covered	Provides information and support to young people experiencing symptoms of psychosis for the first time. Available for ages 15-25.
Substance use treatment	Covered	You can get substance use disorder (SUD) services without a referral. Inpatient SUD, residential and detox services need preapproval.
Crisis services	Covered	No limits to the number of visits. No referral or preapproval required.
Specialty Services such as Neuropsych and Psychological Evaluations	Covered	These evaluations need to be prior authorized and meet medical necessity and / or medical appropriateness

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.

Your next chapter in healthcare starts with you

Your next chapter in healthcare starts with you

What does your health plan cover?

Coverage by age

Questions?

Your Resources

Your Community