|
Being pregnant is a time when you need to pay close attention to your health benefits. TRICARE benefits include prenatal care, labor, delivery care and postpartum care. If you are eligible for TRICARE maternity care, there are a few details about the benefit that you need to know.
Eligibility
Any woman eligible for TRICARE benefits may receive maternity care from the first obstetric visit through six weeks after delivery.
Referrals and Authorizations
If you think you are pregnant, or you know you are currently expecting, contact your primary care manager (PCM) immediately to consult with them on your options. If the military treatment facility is unable to meet your obstetric needs, or if your assigned network PCM does not specialize in obstetrics or gynecology (OB/GYN), then your PCM will need to refer your care to a network specialist. Obstetric services that are referred to the network are approved as a “global” (beginning to end) service, beginning with the first prenatal visit and remaining valid until 42 days following delivery.
If you intend to deliver in a civilian (non-military) hospital or birthing center, your OB/GYN must obtain a separate authorization for the facility delivery portion of your maternity care. This authorization may be obtained by your OB/GYN physician in your third trimester, or the hospital facility may contact Humana Military at the time of delivery to obtain the authorization. TRICARE Prime beneficiaries and network providers should use network facilities for delivery.
What’s Covered/Not Covered
TRICARE covers maternity-related treatment based on medical necessity.
TRICARE covers:
- Services and supplies associated with prenatal care, labor, delivery and postpartum care
- Anesthesia for pain management during delivery
- An ultrasound as medically necessary. Determining gender is not considered medically necessary. Maternity ultrasound is covered only with diagnosis and management of conditions that constitute a high-risk pregnancy.
- TRICARE-certified/authorized birthing centers
TRICARE does not cover:
- “Routine” ultrasounds. If a provider or beneficiary wishes to perform a routine ultrasound, it will not be covered in addition to or separate from the global maternity benefit. Beneficiaries can choose to pay for a routine ultrasound separately from their TRICARE benefits.
- Off-label use of FDA-approved drugs for preterm labor
- Home Uterine Activity Monitoring (HUAM), telephonic transmission of HUAM data or HUAM-related telephonic nurse or physician consultation
- Lymphocyte or paternal leukocyte immunotherapy for the treatment of recurrent spontaneous fetal loss
- Salivary estriol test for preterm labor
- Personal comfort items such as private rooms and televisions after delivery
For more information about maternity care, contact Humana Military at 1-800-444-5445 or visit www.humana-military.com.
|
|
|
Key Points to Remember for Expectant Mothers
- If you and your spouse are both active duty service members, either of you can become the baby’s sponsor.
- If you are a retired service member and you are enrolled in the TRICARE Prime individual plan (enrollment fees of $230), adding the baby to your plan will put you into the family plan, increase your enrollment fee to $460 and establish a new 12-month enrollment period for both members.
- If you are a TRICARE-eligible unmarried daughter (of an ADSM or retiree), only your maternity care will be cost-shared. The baby is not eligible for TRICARE unless your sponsor adopts the child or the father is active duty or retired.
- If your TRICARE eligibility ends during the pregnancy (e.g., due to discharge of sponsor), TRICARE will not cover any remaining maternity care unless you qualify for the Transitional Assistance Management Program (TAMP) or you have enrolled in the Continued Health Care Benefits Program (CHCBP). Learn more about TAMP and CHCBP through the TRICARE Web site at www.tricare.mil.
|
|
