TitleWeb
No member cost-sharing for breast pumps
Professional; Ancillary
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The Patient Protection and Affordable Care Act requires that group health plans
and health plan insurers cover designated preventive services, including
certain women?s preventive health services, for members at 100 percent (i.e.,
$0 costsharing). These services include breastfeeding support, supplies, and
counseling from in-network providers during pregnancy and/or in the postpartum
period.
Recently the government made clarifications regarding the terms of this
coverage to include both the rental and purchase of breast pumps. Therefore, as
of April 1, 2013, members can purchase one portable manual or electric breast
pump, plus supplies, per pregnancy from a participating in-network durable
medical equipment (DME) provider with no member cost-sharing.
Note: The rental of hospital-grade breast pumps requires approval for medical
necessity. Rentals are available at no cost-sharing only for those members who
require the use of a hospital-grade pump. If approval is obtained for medical
necessity, member cost-sharing will not be applied when the member rents the
breast pump from an in-network DME provider.
If you or your IBC patients have any questions about this coverage, please call
Customer Service at []1-800-ASK-BLUE[].