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General Services

For Children Who Are 5 to 18 Years of Age.

Screening services include:

  • A comprehensive physical examination
  • A comprehensive health and developmental history
  • Developmental appraisal (including mental, emotional and behavioral)
  • Anticipatory guidance and health education
  • Measurements
  • Dental/oral health assessment
  • Vision and hearing tests
  • Certain laboratory procedures
  • Lead risk assessment
  • Immunizations, as needed, to be given at the time of screening services

Checkup schedule: 5 to 18 years of age—one exam each year 

Co-Payment (due at the time of service): $0


Generic prescriptions (31-day supply) 

Brand-name prescriptions (available only if no generic is available or if the brand name is considered medically necessary) 

Co-Payment (due at the time of service): $5 per prescription

Primary Care Physician Services

Well-child care visits

Covered services include:

  • Office visits
  • Medical and surgical care and consultation
  • Diagnosis
  • Treatment

Co-Payment (due at the time of service): $5 per visit



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Last Updated On: 11/30/2015