TRICARE Maternity Care PDF

TRICARE ® Maternity Care If you’re pregnant, your care and costs are determined by your beneficiary status, how close you live to a military hospital or clinic that provides obstetric and gynecological services, and your choice of TRICARE plan and provider. MATERNITY CARE COVER...

TRICARE ® Maternity Care If you’re pregnant, your care and costs are determined by your beneficiary status, how close you live to a military hospital or clinic that provides obstetric and gynecological services, and your choice of TRICARE plan and provider. MATERNITY CARE COVERAGE TRICARE covers the following maternity care services: COSTS Obstetric visits throughout your pregnancy Active duty service members and active duty family members have no costs for maternity care Fetal ultrasounds when enrolled in a TRICARE Prime plan. Management of high-risk or complicated pregnancies All others (including those enrolled in TRICARE Hospitalization for labor, delivery, and postpartum care Select, TRICARE Reserve Select, TRICARE Deliveries at TRICARE-certified/authorized birthing Retired Reserve, TRICARE Young Adult Select, centers or deliveries planned at home (stateside only) the Continued Health Care Benefit Program, Note: Home births aren’t covered in overseas locations. and retirees, their family members, and all Contact your regional contractor for specific guidance. others) have copayments, cost-shares, or Anesthesia for pain management during labor both. For detailed cost information, go to and delivery www.tricare.mil/costs. Cesarean sections Beneficiaries with a TRICARE Prime plan (except Breast pumps, breast pump supplies, and for ADSMs) may use the point-of-service option to breastfeeding counseling self-refer to an obstetrician but will pay higher out- of-pocket costs. For more information about the Additional childbirth and breastfeeding services (including POS option, go to www.tricare.mil/pointofservice. certain doulas and lactation specialists) are available to TRICARE Prime and TRICARE Select enrollees under the Childbirth and Breastfeeding Support Demonstration. The demonstration is available stateside and overseas. Learn more at www.tricare.mil/cbsd. For more information on covered services, go to www.tricare.mil/coveredservices. This brochure isn’t all-inclusive. For more information, go to www.tricare.mil. GETTING MATERNITY CARE Your guidelines for getting care vary based on your TRICARE health plan and whether you live stateside or overseas. Maternity care services may require referrals, pre-authorizations, or both. HEALTH PLAN GUIDELINES TRICARE Prime If your primary care manager is at a military hospital or clinic with maternity care services, the military hospital or clinic will provide your maternity care. If maternity care is unavailable at your military hospital or clinic, your PCM will refer you to a civilian network provider. If you have a civilian PCM, your PCM will direct your maternity care or give you a referral to an obstetrician. TRICARE Prime Remote If you have an assigned PCM, your PCM may direct your care. Otherwise, you may visit a TRICARE-authorized civilian provider with pre-authorization from your regional contractor. TRICARE Select and You may get care from any TRICARE-authorized provider without a referral. Visits to a network TRICARE Reserve Select, provider will cost you less out of pocket, and the provider will file claims for you. With a non- TRICARE Retired Reserve, network provider, you may pay more out of pocket and have to file your own claims. Non-network and Continued Health Care providers may charge up to 15% above the TRICARE-allowable charge. You’re responsible for that Benefit Program stateside amount, in addition to any deductible or cost-shares. TRICARE Prime Overseas If your PCM is at a military hospital or clinic with maternity care services, you’ll get your and TRICARE Prime Remote maternity care there. If your military hospital or clinic doesn’t offer maternity care services, your Overseas PCM will refer you to a civilian network provider. If you have TRICARE Prime Remote Overseas, you can call the TRICARE Overseas contractor for help coordinating care. TRICARE Select Overseas You may seek care from almost any TRICARE-authorized civilian provider without a referral. There and TRICARE Reserve may be specific requirements or limitations for midwives or other provider types in overseas Select, TRICARE Retired locations. Contact the TRICARE Overseas contractor for a benefit review and to ensure your Reserve and Continued provider is TRICARE-authorized. Overseas providers aren’t required to bill TRICARE on your Health Care Benefit Program behalf. You should expect to pay up front for care and submit a claim with proof of payment to overseas get reimbursed. Outside the U.S. and U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands), there may be no limit to the amount that nonparticipating non-network providers may bill. You’re responsible for paying any amount that exceeds the TRICARE-allowable charge, in addition to your deductible, cost-shares, and copayments. For more information, visit www.tricare.mil/selectoverseas. Note: If you live in or travel to the Philippines, you’re encouraged to visit Philippine Preferred Provider Network providers. Your out-of-pocket costs are lower when you use a PPN provider. Learn more at www.tricare-overseas.com/beneficiaries/philippines. TRICARE Young Adult Young adults who have purchased coverage under TYA follow the rules (including costs and provider choices) of the plan they have—either TYA Prime or TYA Select. TRICARE Dental Program During pregnancy, a third cleaning is covered in a 12-month period. 2 COVERAGE FOR YOUR NEW CHILD For children of retirees, there’s no automatic enrollment process. Within 90 days of birth, adoption, or court appointment, you must: Your child has separate TRICARE coverage after they’re born. However, the sponsor must register the new child in the Register your child in DEERS. Defense Enrollment and Eligibility Reporting Systems within Contact your regional contractor to enroll your children in a 90 days (120 days if overseas) of birth, adoption, or court TRICARE plan. appointment. To do this, the sponsor must go to a Uniformed Visit milConnect (https://milconnect.dmdc.osd.mil) to Services ID card office and present the child’s official birth confirm your child’s enrollment within 90 days of birth, certificate or FS-240 Consular Report of Birth Abroad, record adoption, or court appointment. After 90 days, you must wait of adoption, or letter of placement of your child into your until another QLE or TRICARE Open Season to enroll your home by a recognized placement or adoption agency or the child in a different TRICARE plan. court. If registered in DEERS after the allotted time period, Overseas Enrollment your child will only be able to get military pharmacy services and care at a military hospital or clinic, if An ADSM has 120 days to register their new child in DEERS. space is available. The sponsor can only enroll the Once registered, the child will automatically be enrolled in child in an eligible TRICARE plan either after another TRICARE Select Overseas. You have 90 days from the auto- Qualifying Life Event or during the annual TRICARE Open enrollment date to change your newborn’s enrollment to Season. Typically, QLE and open season enrollment rules don’t TRICARE Prime Overseas or TRICARE Prime Remote Overseas, apply to newborn TRS or TRR members. You must register if eligible and command-sponsored. Otherwise, your child stays newborns in DEERS before they can qualify for coverage. Visit in TRICARE Select Overseas. https://idco.dmdc.osd.mil/idco to find a Uniformed Services If the sponsor enrolls the new child in TRICARE Prime Overseas ID card office in your area. or TRICARE Prime Remote Overseas, coverage is backdated to the birth date. The family may ask the TRICARE Overseas TRICARE Prime® and TRICARE Select® Program contractor to reprocess any claims that were denied or should be processed under TRICARE Prime Overseas or Once registered in DEERS, a newborn, adopted, or court- TRICARE Prime Remote Overseas. appointed child of an ADSM will be automatically enrolled in a TRICARE plan based on where the child lives. Retirees have 120 days from the date of birth, adoption, or court appointment to register their child in DEERS and enroll them in TRICARE Select Overseas. Stateside Enrollment Children of ADSMs are automatically enrolled in TRICARE Prime as long as: TRICARE Reserve Select® and TRICARE Retired Reserve® They’re registered in DEERS. Your child will be covered by TRS or TRR if you purchased They live in a stateside Prime Service Area. If they don’t live family coverage, registered them in DEERS, and enrolled them in a PSA, the child will be automatically enrolled in TRS or TRR. Submit your child’s enrollment form to your in TRICARE Select. regional contractor within 90 days (120 days if overseas) of birth You may choose to change your child’s coverage to another or adoption. For information about covering your child with TRICARE plan, if eligible, within 90 days from the date entered TRS or TRR family coverage, visit www.tricare.mil/trs or in DEERS. www.tricare.mil/trr. TRICARE Young Adult HOW TO ENROLL OR CHANGE ENROLLMENT A new child of a TYA member isn’t covered by TRICARE unless Once your child is registered in DEERS, you can the child’s other parent is a sponsor or the child is adopted by a enroll or make enrollment changes online, by sponsor. They also won’t be able to get care at military hospitals phone, by mail, or in person at a TRICARE Service and clinics. Center (overseas only). For details and instructions, visit www.tricare.mil/enroll. 3 Continued Health Care Benefit Program your original enrolled location, you need to coordinate with your PCM to get referrals for nonemergency healthcare services If your child is born, adopted, or court appointed while you have in the location you’re visiting. To transfer your enrollment, CHCBP coverage, you may not need to register them in DEERS. contact your regional contractor. Contact the CHCBP contractor, Humana Military, to enroll your child in the CHCBP. Visit www.tricare.mil/chcbp for more Overseas, different rules apply. Contact your TOP Regional Call information. Center for guidance. If you’re using TRICARE Select or TRICARE Select Overseas, Children Born to Covered Family Members you may get care from any TRICARE-authorized provider (unless local country restrictions apply) in your new location If you’re a TRICARE-eligible unmarried child of a TRICARE without a referral. sponsor, TRICARE will cover your pregnancy care before, during, and after childbirth. However, TRICARE doesn’t cover your new baby unless the child’s other parent is a sponsor. In IF YOU LOSE TRICARE ELIGIBILITY certain situations, your newborn may be eligible for care under the Secretarial Designee Program, subject to the decision of your You may lose TRICARE eligibility, including maternity military hospital or clinic’s commander. coverage, for various reasons related to life events and sponsor status changes. Depending on the reason for losing eligibility, you may qualify for continued coverage under the Transitional RELOCATING DURING YOUR PREGNANCY Assistance Management Program or CHCBP. CHCBP requires premium payments. If you’re an ADSM who’s pregnant at If you move and change your address in DEERS, this is a QLE. the time of release from active duty, you may also work with Visit www.tricare.mil/lifeevents to learn more. your service (unit personnel and military hospital or clinic If you have TRICARE Prime and plan to be out of your current administrative channels) to determine if you’re eligible for area during your pregnancy for more than 30 days, you may ongoing care at a military hospital or clinic. either keep your current TRICARE Prime enrollment or transfer Visit www.tricare.mil/maternitycare for more information. your enrollment, if you’re eligible for TRICARE Prime in your new location. If you keep your TRICARE Prime enrollment in LOOKING FOR More Information? TRICARE East Region TRICARE West Region TRICARE Overseas Program Humana Military TriWest Healthcare Alliance International SOS 800-444-5445 888-TRIWEST (888-874-9378) Government Services, Inc. www.tricare.mil/east www.tricare.mil/west www.tricare-overseas.com For toll-free contact information, visit US Family Health Plan Transitional Assistance Management www.tricare-overseas.com/contact-us www.tricare.mil/usfhp Program www.tricare.mil/tamp TOP Regional Call Centers Continued Health Care Benefit Program Defense Enrollment Eligibility Eurasia-Africa www.tricare.mil/chcbp Reporting System +44-20-8762-8384 (overseas) www.tricare.mil/deers 877-678-1207 (stateside) [email protected] An Important Note About TRICARE Program Information Latin America and Canada At the time of publication, this information is current. It’s important to remember that +1-215-942-8393 (overseas) BR402G100125WP 877-451-8659 (stateside) TRICARE policies and benefits are governed by public law and federal regulations. Changes to TRICARE programs are continually made as public law and/or federal regulations are [email protected] amended. Military hospital and clinic guidelines and policies may be different than Pacific those outlined in this publication. For the most recent information, contact your TRICARE +65-6339-2676 (overseas) regional contractor or local military hospital or clinic. 877-678-1208 (stateside) [email protected] TRICARE is managed by the Defense Health Agency. DHA and TRICARE are registered trademarks of the Department of Defense, Defense Health Agency. All rights reserved. Updated January 2025