Breastfeeding support and counseling
The Affordable Care Act (ACA) includes guidelines for coverage of breastfeeding support and counseling. Effective July 1, 2012, if you are covered by a non-grandfathered HMSA plan that has implemented the ACA provisions, you now have 100 percent coverage for breast feeding support and counseling by a trained, participating physician or midwife during pregnancy and/or after giving birth (postpartum). This provision also includes the purchase of a breast pump, limited to one per pregnancy from an HMSA participating provider or medical pharmacy. The breast pump is covered at no charge (no copayment, deductible, or coinsurance).
Obtaining a breast pump
All available brands and models will be covered as long as the breast pump is obtained from one of the HMSA participating providers or medical pharmacies (when purchased at the pharmacy) listed in this brochure.
You may get the breast pump before or after giving birth. The breast pump can be manual or electric and does not require a prescription from a physician to be covered.
Mothers who rent a hospital grade breast pump will be allowed to obtain a breast pump for the same pregnancy after returning the rental. The benefit, which is effective July 1, 2012, allows mothers one purchase per pregnancy.
Noncovered services
HMSA will not cover replacement breast pumps. If you are not happy with the first breast pump obtained with your HMSA plan, purchase of a replacement will not be covered. It is best to research and find the breast pump you would like to use before obtaining one from a participating provider or medical pharmacy.
If you obtain your breast pump at a participating store, please make sure to purchase it at the pharmacy counter. HMSA also does not cover the cost of supplies that do not come with the breast pump or supplies to replace old supplies that came with the pump. Disposable supplies such as replacement milk storage bags, ties, breast shields, batteries, etc., are also not covered.
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