TRICARE Maternity Coverage -- What's covered, what's not

  • Published
  • By By Diane Mayer
  • TriWest Healthcare Alliance
ELLSWORTH AIR FORCE BASE, S.D. --  TRICARE's maternity benefits include prenatal care, labor, delivery and postpartum care. Members eligible for TRICARE maternity coverage can consider these steps that will help members make the most of their benefits:

Step 1: Visit your primary care manager
If a member is potentially pregnant, or expecting, the primary care manager is the first stop because the member may need authorization to see a specialist or a referral to ensure that the care is covered by TRICARE. It may also avoid higher out-of-pocket costs.

Step 2: Know your benefits
TRICARE covers:
· An ultrasound or sonogram determined to be medically necessary. A maternal ultrasound is covered only with diagnosis and management of conditions that constitute a high-risk pregnancy.
· Services and supplies associated with prenatal care, labor, delivery and postpartum care
· Anesthesia for pain management during delivery
· Emergency cesarean section
· Subscription to free weekly e-mail parenting newsletter, "eCareConnect" via www.theparentreview.com/DoD

TRICARE does NOT cover:
· Personal comfort items such as private rooms and televisions after delivery
· "Routine" ultrasounds, including ultrasounds to determine gender. You may choose to pay for a routine ultrasound separately from your TRICARE benefits.
· Treatments, procedures and technologies related to artificial methods of reproduction including artificial insemination, in vitro fertilization, gamete intrafallopian transfer or the reversal of a prior surgical sterilization.

*NOTE: These lists are not all-inclusive. To determine if a specific service is covered, visit www.triwest.com/beneficiary/benefits.aspx.

Step 3: Enroll within 60 days of birth or adoption
· Married members who are both active duty choose which person to designate as the baby's sponsor.
· Register children in the Defense Enrollment Eligibility Reporting System as soon as possible after the birth or adoption.
· Once a baby is registered in DEERS, the member will need to enroll the baby in TRICARE Prime or Prime Remote within 60 days of birth or adoption. A child is covered as a TRICARE Prime or TPR beneficiary for the first 60 days following birth or adoption as long as one additional family member is enrolled in TRICARE Prime or TPR. If the child is not enrolled in TRICARE Prime or Prime Remote within 60 days, coverage will revert to the TRICARE Standard program option on the 61st day (which carries additional deductibles and cost-shares), until the child is enrolled in TRICARE Prime. The child's eligibility for TRICARE Standard ends 365 days after birth or adoption if it is not properly registered in DEERS.

For more information visit www.triwest.com/beneficiary/benefits.aspx or www.tricare.mil, or call (888) 874-9378.