EOCCO preventive services for kids 0-12 years old

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

Medical
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.

Vision
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
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.

Dental
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.

Pharmacy
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

Screenings
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.

Give your child a healthy start

Give your child a healthy start

What does your child’s health plan cover?

Coverage by age

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