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:
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.|
|Provider visit and mental health assessments||Covered||Your child 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.|
|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|
View benefits and coverage for other age groups.
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EOCCO members should have their member ID number ready for quicker help.See more options