Maternity

Regular Army: Active Duty

Benefit Fact Sheet

Summary

Maternity (or pregnancy) care includes the medical services related to conception through delivery including: Prenatal care, Post-partum care (generally for six weeks after delivery) and, treatment of any complications.

Eligibility

Active duty Service Members (ADSMs) and active duty Family members (ADFMs) have no costs for maternity care under any TRICARE Prime option. Others (including those enrolled in TRICARE Select, TRICARE Reserve Select (TRS), TRICARE Retired Reserve (TRR), TRICARE Young Adult (TYA) Select, the Continued Health Care Benefit Program (CHCBP), and retirees, their Family members and all others) have copayments and/or cost-shares. For detailed cost information, go to www.tricare.mil/costs.

Except for ADSMs, beneficiaries with a TRICARE Prime option may use the point-of-service (POS) option to self-refer to an obstetrician but will pay higher out-of-pocket costs. For more information about the POS option, go to www.tricare.mil/pointofservice.

Benefit Highlights

Prenatal Care
Prenatal care: Care received from the time you find out you are pregnant until delivery. Schedule an appointment with your primary care provider at the earliest signs of pregnancy. Depending on your health plan option, this may be your assigned primary care manager (PCM).

Regular appointments with your doctor are important to make sure you and your baby are healthy. At the first appointment, you'll find out the due date and explore your health history. Frequent prenatal visits allow you to follow the progress of your pregnancy and your baby's development and gives you the opportunity to ask questions along the way.

While all medically-necessary prenatal care is covered, there are some limitations.

Antepartum Services
TRICARE covers the following services to determine the health of the baby or if you have a high-risk pregnancy:

  • Amniocentesis

  • Cordocentesis

  • Chorionic villus sampling

  • Fetal stress test

  • Electronic fetal monitoring

Ultrasounds
Doctors often perform ultrasounds at different times during pregnancy for different reasons. TRICARE will cover ultrasounds used to:

  • Estimate gestational age

  • Evaluate fetal growth

  • Conduct a biophysical evaluation for fetal well-being

  • Evaluate a suspected ectopic pregnancy

  • Define the cause of vaginal bleeding

  • Diagnose or evaluate multiple gestations

  • Confirm cardiac activity

  • Evaluate maternal pelvic masses or uterine abnormalities

  • Evaluate suspected hydatidiform mole

  • Evaluate the fetus's condition in late registrants for prenatal care

TRICARE does not cover maternity ultrasounds for routine screening or to determine the sex of the baby.

 

Labor and Delivery
TRICARE covers medically-necessary services during your labor and delivery including anesthesia, fetal monitoring, and other services required for your care during your stay. TRICARE will cover a cesarean section when needed. If you choose to have a cesarean section instead of vaginal delivery for personal reasons, you may be responsible for some of the costs.

Facility/Provider
Usually, your TRICARE plan determines the type of birthing facility you will use (military or civilian, office-based or freestanding, etc.). Options for the type of provider who delivers your baby include: obstetrician, Family practice provider and or Certified nurse midwife, etc.

Length of Stay
Minimum of 48 hours after a vaginal delivery and 96 hours after a cesarean section. Complications may require a longer stay.

Post-partum Care
Post-partum care is the care after the baby is born. TRICARE covers a minimum of two post-partum visits. More visits are covered if medically necessary.

Other Considerations

  • Maternity Supplemental Clothing Allowance: Is provided to enlisted active duty Army National Guard and Reserve pregnant Service members. Purchase of the service dress uniform is mandatory. This uniform consists of the maternity jumper and one long sleeve blue maternity blouse. This allowance is paid only once in a three-year period.

  • Leave: The Military Parental Leave Program (MPLP) provides non-chargeable leave entitlements following the birth or adoption of a Child. The policy applies to Soldiers who are birth mothers and fathers, same-sex couples, as well as adoptive and surrogate parents

  • DEERS: Beginning from the Child’s birthdate or date of adoption you have 90 days within the Continental United States (CONUS) and 120 days Outside Continental United States (OCONUS) to register in DEERS. Once registered you have an additional 90 days to enroll in or change health plans.

  • Newborn Care: Services provided for your infant are covered separately from the parent. TRICARE offers well-childcare for children under age 6 (from birth through age 5), which includes:

    • Circumcision (before leaving hospital)

    • Routine newborn care

    • Comprehensive health promotion and disease prevention examinations

    • Vision and hearing screenings

    • Height, weight and head circumference

    • Immunizations

    • Developmental/behavioral appraisal 

Be sure to schedule your newborn's first well-child appointment before you leave the hospital.

 

Additional Information
Document Review Date: 04 February 2020