TRICARE Delivers for Mothers and Newborns
By Alexis D. Washington
TRICARE Management Activity
September 07, 2010 Source: http://www.tricare.mil/
TRICARE offers pregnant beneficiaries several health care options for services before, during and after childbirth.
All medically necessary maternity care, from the first obstetric visit through six weeks after the child is born is covered by TRICARE. These services include obstetric visits, management of high-risk or complicated pregnancies and hospitalization for labor, delivery and postpartum care. More TRICARE services covered include the use of certified nurse midwives, anesthesia for pain management during labor, delivery and cesarean sections. Medically necessary ultrasounds are also covered.
How to Get Care
Services and their associated costs are determined by the beneficiary’s status. How beneficiaries access maternity care depends on which health plan option the beneficiary is enrolled in.
TRICARE Prime
TRICARE Prime beneficiaries may receive maternity services at their local military treatment facility (MTF) when available. If MTF care is unavailable or doesn't provide obstetric services, beneficiaries will be referred to a civilian network provider by their primary care manager (PCM). Some MTFs provide prenatal and postpartum care and use a local civilian hospital for childbirth.
Beneficiaries have options in choosing a provider. TRICARE Prime beneficiaries can disenroll from TRICARE Prime and convert to TRICARE Standard to receive maternity care from a non-network civilian provider. This will allow them to avoid Point-Of-Service charges, but they will incur normal TRICARE Standard cost shares. TRICARE Prime beneficiaries should ensure they have the required referrals and authorizations before seeking non-emergency care outside of the MTF.
TRICARE Prime Remote
TRICARE Prime Remote enrollees will be directed by their PCM for care or may visit a TRICARE-authorized civilian provider. All civilian maternity services require prior authorization from the appropriate regional contractor.
TRICARE Standard/Extra
TRICARE Standard enrollees may choose any TRICARE Standard authorized provider for maternity care, even if they live close to a MTF. TRICARE Standard beneficiaries don’t need a referral or authorization when they use any TRICARE-authorized provider for maternity care.
After Giving Birth
Postpartum care is generally covered for up to six weeks after the baby is born.
TRICARE Prime covers newborns immediately after birth and for the next 60 days, as long as at least one other family member is enrolled in TRICARE Prime or TRICARE Prime Remote. To ensure he or she remains covered by TRICARE Prime after the first 60 days, the baby must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) and enrolled in TRICARE Prime. The website address for DEERS is www.tricare.mil/DEERS.
Newborns can be registered in DEERS at a uniformed services identification card-issuing facility. A birth certificate or certificate of live birth from the hospital is required. After registering a baby in DEERS, he or she is to be enrolled in TRICARE Prime or TRICARE Prime Remote Active Duty Family Member within 60 days after birth via the Beneficiary Web Enrollment website at www.dmdc.osd.mil/appj/bwe/ or by submitting DD Form 2876 to the appropriate regional contractor. Newborns not enrolled by day 61, will be covered under TRICARE Standard and TRICARE Extra. The enrollment period for TRICARE Prime and TRICARE Prime Remote Overseas is 120 days.
There are so many things to consider when it comes to maternity care and the first resource is a PCM. Additional information about maternity care benefits visit http://tricare.mil/baby.
Regional contractors can also provide assistance with getting maternity care.
TRICARE North Region
Health Net Federal Services, LLC
1-877-TRICARE (1-877-874-2273)
www.healthnetfederalservices.com
TRICARE South Region
Humana Military Healthcare Services, Inc.
1-800-444-5445
www.humana-military.com
TRICARE West Region
TriWest Healthcare Alliance Corp.
1-888-TRIWEST (1-888-874-9378)
www.triwest.com
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