No member cost-sharing for breast pumps
May 1, 2013
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.