EOCCO preventive services for teens 13-16 years old

Teenagers go through many changes. What should stay the same are the regular visits with their doctor and dentist. Scheduling regular doctor visits, vaccinations, tests, and routine dental exams can help keep them in good health during their teenage years.

Knowing what services your teen’s health plan covers is important. Making sure they are 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 teen’s plan so they can get the care they need.

Here are a few things to consider for your teenager:

Choose a pediatric doctor and dentist. Choosing and keeping a relationship with their doctor and dentist is important for their overall health and development during their early teen years.
• Schedule regular physical exams. These visits may include talking to their doctor about important topics such as physical, social and emotional development, getting caught up on their shots, reproductive health and healthy relationships, exercise and eating right.
Schedule dental visits. Regular dental checkups are also good for your teen’s overall health. These visits may include a cleaning, sealants, fluoride and X-rays.

What does your teen’s 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	All EOCCO members have an in-network PCP or clinic assigned to them.
Adolescent well-check	One visit per calendar year	It is important to schedule a checkup every year. Your teen's doctor will provide a physical exam and discuss important topics such as physical, social and emotional development, getting caught up on shots, safe sex, healthy eating, exercise, and how to manage stress in a confidential setting.
Immunizations (shots)	Covered	A referral is not needed. Your teen's doctor or any network provider can provide these.
Emergency room	Covered	An emergency is a condition that puts your teen's life in danger. Call 911 or go to the emergency room when you think your teen is in danger.
Urgent care	Covered	Care that your teen 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 teen will need a referral from their doctor before seeing a specialist.
Hospital	Covered	Prior approval is needed for in-patient hospital stays. Your teen's doctor will get this approval. The prior approval is not needed in an emergency.
Labs, tests, X-rays	Covered	These are covered if your teen's 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 child's doctor or other healthcare provider believes they may be at risk. Your teen may also request these services from their provider.
Birth control supplies & education	Covered	Your teen's pediatrician or other health care professional will discuss different birth control options with them. Your teen's plan covers their choice of birth control, including emergency contraception.
Pregnancy test	Covered	Pregnancy tests are covered when ordered by a healthcare provider.

Vision
Exam	Every 12 months	May be covered more often if your teen's doctor or optometrist recommends it.
Glasses and contact lenses	Every 12 months	May be covered more often if your teen's doctor or optometrist recommends it.

Hearing
Hearing test	Covered	If your teen is needing hearing services, their doctor will make a referral.
Hearing aids	Covered	If your teen 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.
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.
Specialty Services such as Neuropsych and Psychological Evaluations	Covered	These evaluations need to be prior authorized and meet medical necessity and / or medical appropriateness.
Crisis services	Covered	No limits to the number of visits. No referral or preapproval required.

Dental
Preventive services	Covered	Exams, cleanings, flouride, varnish, and X-rays. Sealants covered for age 16 and younger.
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 teen's 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. Examples include: toothache, swollen gums, lost filling.
Emergency dental care	Covered	24 hours, 7 days a week. In a dental emergency, call your teen's dentist day or night.

Pharmacy
Prescription medications	Covered	These are medications that a doctor specialist or other provider prescribes. Your teen 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
Weight assessment and counseling in adolescents	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.

Keep your teenager on a healthy track

Keep your teenager on a healthy track

What does your teen’s health plan cover?

Coverage by age

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