TRICARE updates breast pump policy


Wiesbaden Army Health Clinic

TRICARE recently revised coverage for breastfeeding supplies.

TRICARE recently revised coverage regarding breastfeeding supplies and services. The policy now clarifies the specific types of breast pumps and supplies covered. The updated policy also added coverage for two additional breastfeeding supplies. TRICARE continues to cover breast pumps, breast pump supplies, and breastfeeding counseling at no cost for new and adoptive mothers. However, new limits and exclusions apply.

Here are the updates:
• TRICARE added a payment cap for manual and standard electric breast pumps. All supplies needed for the operation of the breast pump are included in the cap amount. As of March 2019, TRICARE pays $312.84 for stateside and $500.55 for overseas beneficiaries. For more about these rates, visit www.health.mil.
• TRICARE put limits on the amount and frequency of replacement supplies. You’ll need a new prescription from your health care provider for replacement supplies over the new limits. The prescription must be specific to the supplies needed. Visit the TRICARE website for a list of covered breast pump supplies.
• TRICARE reduced the number of covered breast pump kits from two to one per birth event. The delivery and all parts and supplies needed for the operation of the breast pump are included in the payment rate for the initial breast pump. The breast pump kits may not be separately reimbursed.
• TRICARE added coverage for one supplemental nursing system and two sets of nipple shields per birth event. A birth event starts at the 27th week of pregnancy, birth of a child prior to 27 weeks, or the legal adoption of an infant by a woman who plans to breastfeed. A TRICARE-authorized provider must prescribe these supplies.


Who can get a breast pump, supplies and breastfeeding counseling services?
All TRICARE-eligible female beneficiaries with a birth event can utilize this breastfeeding service. A birth event includes a pregnant beneficiary or a female beneficiary who legally adopts an infant and intends to breastfeed. You can get these items before or after delivery.
It doesn’t matter what TRICARE plan you use or your sponsor’s status (active duty or retired).

Where can I get a breast pump?
You can get a breast pump from:
A TRICARE network durable medical equipment provider
Defense Commissary Agency
Post Exchange, Base Exchange, or other Army and Air Force Exchange Service affiliated station exchange
Civilian stateside or overseas retail store
Online store (standard shipping and handling is covered)

Is there a list of approved providers I can buy a breast pump from?
No, there isn’t a specific list. TRICARE pays up to a set amount for a breast pump and initial breast pump kit. Rates may change annually (As of March 2019, the rates are $312.84 stateside or $500.55 overseas).
How do I get a breast pump?
There are a few steps to follow when using TRICARE’s reimbursable benefit.
Step 1: Obtain a prescription
Your prescription must be from a TRICARE authorized provider.
For Wiesbaden Army Health Clinic patients this would be the OB nurse.
The prescription does not need to specify a particular brand.
The prescription does need to specify basic manual or standard electric pump.
Step 2: Get a pump
Purchase your pump from any of the approved options listed above.
Step 3: File a claim
Complete a DD 2642.
Attach a copy of the prescription and receipt.
Fax, mail, or upload claim to WPS, our regional contractor for claims. The TRICARE Service Center is available to provide guidance and answer questions.

What if I cannot afford a breast pump?
For any beneficiary that is not financially able to purchase a breast pump, there are community resources available that will provide breast pumps. Women, Infants and Children Overseas, Army Community Service and New Parent Support can provide additional details for beneficiaries in need.

What breast pump supplies are covered?
TRICARE covers:
One breast pump kit per birth event. The kit may not be separately billed for and reimbursed.
Standard power adapters: One replacement per birth event and not within 12 months of the breast pump purchase date.
Tubing and tubing adapters: One set per birth event.
Locking rings: Two every 12 months
Bottles: Two replacement bottles and caps/locking rings every 12 months following the birth event
Bottle caps: Two every 12 months after the birth event
Storage bags: 90 bags every 30 days following the birth event
Valves/membranes: 12 for each 12 months following the birth event
Supplemental Nursing System (SNS): One per birth event when a physician prescribes
Nipple shields/splash protectors: Two sets per birth event when a physician prescribes
You may receive supplies in excess of the above limits when your provider prescribes them and when they are medically necessary.

Where can I get breast pump supplies?
You can purchase supplies through the same locations you can purchase breast pumps.

When can I get breast pump supplies?
Breast pump supplies can be purchased prior to delivery, starting at 27 weeks, or up to three years after the birth event. The three-year period starts on the child’s birth date or the date of the legal adoption.

How do I get reimbursed for breast pump supplies?
The same steps are followed for breast pump supplies as when seeking reimbursement for the pump itself.
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Patients enrolled to the Wiesbaden Army Health Clinic are encouraged to attend the OB classes offered by the clinic. Information is shared with regard to how your TRICARE benefits work for you in your overseas location. Information is available at www.tricare.mil.