Global maternity care includes prenatal care from the first obstetric (OB) visit, labor and delivery, postpartum care for up to six weeks after the birth of the child and treatment of complications. Global maternity care authorizations include birthing support services in the maternity episode-of-care; beneficiaries do not need a separate referral for these services. Note: An office visit to determine or confirm pregnancy is not considered part of the global maternity care and is covered separately as an office visit.
Childbirth and Breastfeeding Support Demonstration
TRICARE will allow for certified labor doulas, lactation consultants and lactation counselors – currently excluded as TRICARE-authorized provider types under the TRICARE benefit – to provide reimbursable care to TRICARE beneficiaries under its Childbirth and Breastfeeding Support Demonstration. This is a five-year demonstration that starts on Jan. 1, 2022.
Maternity Care Authorizations and Referrals
TRICARE Prime and TRICARE Prime Remote beneficiaries require a referral from Health Net Federal Services, LLC (HNFS) for civilian professional maternity care services (for example, OB/GYN or nurse midwife). Hospital notification of the inpatient admission and birthing center notification of delivery require notification to HNFS within 24 hours of admission or the next business day.
TRICARE Select beneficiaries can obtain all maternity care without an approval from HNFS.
Note: When using a birthing care center, be sure it is TRICARE-certified.
Length of Stay after Delivery
The Newborn's and Mothers' Health Protection Act of 1196 (NMHPA) is a federal law that affects the length of time a mother and newborn child are covered for a hospital stay in connection with childbirth. Health plans are prohibited from restricting benefits to stays less than 48 hours after a vaginal delivery or 96 hours following delivery by Cesarean section.
While this law does not apply to the TRICARE program, the TRICARE policy on maternity inpatient stays is consistent with NMHPA. Please be aware that neither the law, nor the TRICARE benefit prevent the patient from being discharged earlier than 48 or 96 hours if both the patient and the provider are in agreement. Conversely, stays beyond the covered 48 or 96 hours may be a covered benefit if deemed medically necessary.
- Epidural anesthesia for pain management during delivery.
- Medically necessary maternity ultrasounds.
- TRICARE authorized birthing centers.
- Emergency and medically necessary cesarean sections. (Cost-sharing for services and supplies related to elective cesarean sections, those done at the request or convenience of the beneficiary, is limited to what would have been provided for vaginal delivery.)
- Prenatal vitamins that require a prescription.
- Home delivery when performed by a TRICARE network or non-network provider including a certified nurse midwife.
- Birth control issued during postpartum visit.
Be aware of conditions that can lead to postpartum depression. Information on surrogacy can be found on our Benefits A-Z.
What’s Not Covered
- Services and supplies related to noncoital reproductive procedures (artificial insemination, fertility treatment).
- Maternity ultrasounds that are not medically necessary.
- Off-label use of FDA-approved drugs to induce or prevent labor.
- Home uterine activity monitoring (HUAM), telephonic transmission of HUAM data, or HUAM-related telephonic nurse or physician consultation.
- Lymphocyte or paternal leukocyte immunotherapy for the treatment of recurrent spontaneous fetal loss.
- Salivary estriol test for preterm labor.
- Personal comfort items such as private rooms after delivery.
- Any care provided after loss of TRICARE eligibility. (Sometimes expectant mothers lose eligibility during their pregnancy, for example, if the sponsor leaves active duty. TRICARE only covers the maternity care provided prior to the loss of eligibility.)
- Prenatal vitamins that do not require a prescription (over-the-counter vitamins).
- Birthing classes (for example, Lamaze classes), however, they may be provided at the military treatment facility.
- Doulas, as they provide support services rather than medical services and cannot be TRICARE-authorized providers (see our Childbirth and Breastfeeding Support Demonstration page for information about certified labor doula coverage effective Jan. 1, 2022).
- Pregnancy support belts.