TRICARE Maternity Benefits

TRICARE is the health program for activated National Guard and Reserves, active-duty and retired service members, as well as their families and survivors. Expectant mothers on active duty or that are spouses of active duty service members can take advantage of the maternity benefits offered on all of the TRICARE plans.

TRICARE Maternity Benefits

• Maternity benefits provided under all of the TRICARE health plans include prenatal care visits, labor and delivery as well as up to six weeks of postpartum care after childbirth and treatment for any complications. Additional maternity benefits covered include fetal ultrasounds the physician deems medically necessary, emergency cesarean sections and prenatal vitamins that must be prescribed. The plan also covers epidural anesthesia. TRICARE maternity benefits provides newborn care at no cost since newborns are considered enrollees of the plan for up to 60 days.

Benefit Conditions

• Under the TRICARE Prime program, expecting mothers must receive services at their local military treatment facility or from a civilian provider referred by their primary care physician. They must also receive prior authorizations for delivery at the MTF or birthing center, planned cesarean sections and extended hospital stays after delivery. In exchange for following these guidelines, maternity care under this plan is provided at no cost to enrollees and services are covered at 100 percent. Expecting mothers covered under the TRICARE Standard plan can use any TRICARE authorized provider without referrals and must pay annual deductibles and cost-shares for care under the maternity benefits. TRICARE Extra lowers out-of-pocket costs when an expectant mother, already enrolled in the Standard plan, chooses a TRICARE network provider for maternity care.

  If a pregnant active duty service member voluntarily separates from duty during her pregnancy, she will lose her TRICARE coverage as will a pregnant spouse of an active duty service member that voluntarily leaves. Both can apply for transitional health coverage under the Continued Health Care Benefit Program within 60 days of losing their TRICARE coverage. If the active duty service member leaves due to her pregnancy, she can request maternity benefits in a military treatment center that has space available. For involuntary separations, expectant mothers may be eligible for health benefits under the Transitional Coverage Management Program.

Services Not Covered

• While TRICARE maternity benefits cover a significant portion of maternity care, the plans do not cover every service or treatment applicable to pregnancy such as fertility treatments and artificial insemination. TRICARE also does not cover routine ultrasounds or ultrasounds used to determine the gender of the baby. TRICARE coverage dos not include off-label use of any FDA-approved drugs to prevent or induce labor and private rooms when requested for personal comfort. Also, if the newborn's father is not an active duty member or a retiree, the TRICARE plans will not cover costs associated with hospital services or inpatient care for newborns.