EOCCO Benefits for 19-63 year olds
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Take charge of your health

Studies show the more you are involved with your health, the happier you are with your care. Regular doctor visits, vaccinations, tests, and dental exams support good physical and mental health.

As a partner in your journey to better health, we are here to answer any questions about your health plan and help you get the care you need.

Here are a few things to consider:

  • Choose a doctor and dentist. Making sure you have a primary care provider (PCP) and dentist that you can maintain an ongoing relationship with is important for your overall health.
  • Schedule yearly checkups. These visits may include talking to your doctor about important topics such as annual exams and screenings, family planning, healthy aging, exercise and managing stress.
  • Have regular dental checkups. The health of your mouth impacts your overall health. This is why good oral health is important. Regular checkups may include a cleaning, sealants, fluoride and X-rays.
  • Get a referral from your PCP. You must have a referral from your PCP in order to see most specialists (e.g., dermatologist, cardiologist, ENT, oncologist)

What does your health plan cover?

See what medical and dental services your plan will cover.

Benefit type In-network coverage What you need to know
Medical
Primary care provider (PCP) Covered All EOCCO members have an in-network PCP or clinic assigned to them.
Yearly checkups 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. Other preventative screenings and topics may be discussed as well.
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. 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.
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-rays Covered These are covered if your doctor orders them. Other authorized specialists may also order them.
Reproductive health and family planning
Physical exam Covered Women's annual exam, and family planning visit.
STI testing Covered Testing for sexually transmitted infections will be covered if your doctor 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.
Pregnancy test Covered Pregnancy tests are covered when ordered by a healthcare provider. Tests and results are confidential.
Vision
Exam Limited coverage Members age 20 and younger can have an eye exam every 12 months. Pregnant woman 21 or older can have an eye exam every 24 months.
Glasses and contact lenses Limited coverage Members age 20 and younger can have new glasses or contacts lenses every 12 months. Pregnant woman 21 or older can have new glasses or contacts every 24 months.
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 and 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 bring together a team of community members and others needed to support parents, families and children.
Dental
Preventive care Covered Exams, cleanings, flouride, varnish, and X-rays.
Restorative care Covered Treatment for cavities and other problems including: fillings, tooth removal, crowns, and dentures. Root canals on back teeth for pregnant women and adults age 18-20.
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 and 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 dentist day or night.
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
Screenings
Weight assessment and counseling in adolescents Covered Preventive care
Mammogram (breast X-ray) Covered Preventive care
Prostate screening Covered Preventive care
Colorectal screening 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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