EOCCO preventive services for kids 0-12 years old
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Give your child a healthy start

Starting healthy habits early is important for your child’s development from birth to age 12. Scheduling regular doctor visits, vaccinations, tests, and routine dental exams can help keep your child in good health when they are young.

Knowing what services your health plan covers is important. Making sure your child is 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 health plan so you can get the care your child needs.

Here are a few things to consider for your child:

  • Choose a pediatric doctor and dentist. Starting and keeping a relationship with your child’s doctor and dentist is important for their overall health and development.
  • Book regular physical exams. These visits may include talking to their pediatrician about important topics such as physical, social and emotional development, getting caught up on their vaccines, healthy eating and exercise.
  • Schedule dental visits. The American Academy of Pediatric Dentistry recommends that by age one or within six months after your child’s first tooth comes in, they should start to have regular dental checkups. These visits may include a cleaning, sealants, fluoride and X-rays.

What does your child’s health plan cover?

See what medical and dental services your child’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.
Well-child check One visit per calendar year It is important to schedule this well-visit every year. Your child's pediatrician will provide a physical exam and discuss important topics such as physical, social and emotional development, getting caught up on shots, healthy eating and exercise.
Immunizations (shots) Covered A referral is not needed. Your child's doctor or any network provider can provide these.
Emergency room Covered An emergency is a condition that puts your child's life in danger. Call 911 or go to the emergency room when you think your child is in danger.
Urgent care Covered Care that your child 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 child will need a referral from their doctor before seeing a specialist.
Hospital Covered Prior approval is needed for in-patient hospital stays. Your child's doctor will get this approval. The prior approval is not needed in an emergency.
Medical equipment and supplies Covered Prior approval is needed for medical equipment and supplies. Your child's doctor will get this approval. Examples of equipment and supplies include breast pumps, diapers, and diabetic supplies.
Labs, tests, X-rays Covered These are covered if your child's doctor orders them. Other authorized specialists may also order them.
Exam Every 12 months May be covered more often if your child's doctor or optometrist recommends it.
Glasses and contact lenses Every 12 months May be covered more often if your child's doctor or optometrist recommends it.
Hearing test Covered If your child is needing hearing services, their doctor will make a referral.
Hearing aids Covered If your child is needing hearing services, their 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 your child for care coordination services. No referral or preapproval required.
Substance use treatment Covered Your child 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.
Preventive services Covered Exams, cleanings, flouride, varnish, sealants, and X-rays.
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 child's 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 child's dentist day or night.
Prescription medications Covered These are medications that a doctor, specialist or other provider prescribes. Your child can get their prescriptions at any in-network pharmacy. A list of these pharmacies is in the provider directory.
Get more pharmacy-related information
Developmental screening in the first 36 months of life Covered Preventive care
Weight assessment and counseling in children Covered Preventive care
Depression screening and follow-up plan Covered Behavioral health

Coverage by age

View benefits and coverage for other age groups.


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Pharmacy Customer Service 888-474-8539
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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