The Military Health
System’s Family-Centered Care program offers families a world-class
standardized obstetric (OB) benefit while upholding the military’s
unique ability to assist family members whose sponsors are deployed.
Family-Centered Care was launched throughout the Services in
2003. Since then, military treatment facilities have focused
on serving patients and their families better by getting their
staffs fully involved in meeting patient needs and then measuring
their performance at meeting these needs. Beginning with the
first OB visit and continuing after the birth of the child,
the Military Health System wants to be your extended family.
Maternity Care: Important Information for Expectant Mothers
What is new with maternity care in the military?
You have the privilege of making a choice for your maternity
care. Beneficiaries whose first prenatal visit occurs on or
after December 28, 2003, have more choices for their prenatal
care, labor and delivery, and post-natal care under TRICARE.
In 2001, Congress passed a law that allows uniformed services
beneficiaries with TRICARE Standard to choose a civilian provider
for maternity care, even if they live close to a military
hospital. Beneficiaries will no longer need permission (a
non-availability statement) from their local military treatment
facility (MTF) to choose a civilian provider.
What are my options with TRICARE?
There are two main options when choosing a TRICARE package.
These are TRICARE Prime and TRICARE Standard. Each option
has its own advantages and disadvantages.
What are the benefits of TRICARE Prime?
TRICARE Prime uses military providers and hospitals and a
network of civilian providers and hospitals. There are no
yearly deductibles, and co-payments for individual provider
visits are almost always less than in TRICARE Standard. In
most locations, if you have TRICARE Prime you may choose a
primary care manager either from a MTF or a civilian health
care facility. MTF commanders are authorized to enroll beneficiaries
to their MTF before beneficiaries enroll with civilian primary
care managers in the network. The primary care manager is
usually a family physician, internist, pediatrician, or obstetrician/gynecologist.
This provider takes care of routine, outpatient medical problems
and check-ups. If in-hospital or specialty care is required,
including maternity care, you must go to the MTF if the services
are available there. In most
cases, expectant mothers with TRICARE Prime must have their
prenatal care and deliver their babies in the MTF when the
MTF has obstetrical care available.
The Military Health System is committed to providing outstanding,
family-centered and safe maternity care for all of our patients.
We are professional health care providers who understand the
unique needs of our military families, especially in today’s
climate of increasing deployments.
So what has changed for TRICARE Standard patients seeking
maternity care?
Under the new law, a woman whose first prenatal visit occurs
on or after December 28, 2003, may choose a civilian doctor
or midwife for her prenatal care and have her baby in a civilian
hospital under TRICARE Standard. This is available even if
she lives near an MTF where maternity care is delivered. Under
the maternity benefit, TRICARE pays the expenses for prenatal
care, labor and delivery, and post-natal care. However, there
is a co-payment for maternity care. The amount varies based
on your length of stay in the hospital and your sponsor’s
status as an active duty or retired member. The initial newborn
care also is covered under this plan, if the newborn is a
dependent of an active-duty member or a retiree. The attached
table shows possible out-of-pocket costs under TRICARE Standard
and for those enrolled in TRICARE Prime.
I have TRICARE Prime and live in an area where the MTF
provides obstetrical services. Do I have to switch to TRICARE
Standard to get civilian maternity care?
To receive civilian maternity care, you have two options:
use the TRICARE Prime Point-of-Service option, or disenroll
from TRICARE Prime and convert to TRICARE Standard. While
civilian maternity care may seem attractive, there are disadvantages
to pursuing these options.
If you choose the Point-of-Service option, you will incur
significant charges. The TRICARE Prime Point-of-Service option
allows TRICARE Prime enrollees to receive nonemergency, TRICARE-covered
services from any TRICARE-authorized provider without a referral
from their primary care manager or authorization from a health
care finder. Using the TRICARE Prime Point-of-Service option
is more costly to the enrollee, and Point-of-Service charges
are not subject to the catastrophic cap, which means you could
pay more than $1,000 or $3,000 out of pocket in a fiscal year.
However, with the Point-of-Service option, you remain enrolled
in Prime.
If you switch to TRICARE Standard, you will not be able to
re-enroll in TRICARE Prime for a period of one year unless
your sponsor is E-4 or below. During this time, if you need
medical attention other than maternity care, you will be subject
to out-of-pocket expenses, such as deductibles and co-payments.
For example, if a pregnant woman covered by TRICARE Standard
is in a motor vehicle accident, these charges will apply.
In addition, if an infant over three days of age sustains
an injury or illness, these charges apply.
Most MTFs have the resources to take care of TRICARE Prime
patients only. If you have TRICARE Standard, you may be required
to seek care outside the military, paying the required deductibles
and co-payments. These fees may be expensive. Whether or not
medical care is available to TRICARE Standard patients varies
from location to location, and even for different medical
specialties at the same MTF. This sometimes results in unexpected
out-of-pocket expenses. Your TRICARE service center can help
with any questions about your situation. For additional information
you also may check the TRICARE Web site at www.TRICARE.osd.mil.
Tables:
Click on the Table you wish to view.
BENEFICIARY COSTS FOR MATERNITY-RELATED CARE
Non-participating provider may bill the beneficiary up to
an additional 15% of TRICARE allowable charges.
- This amount is updated each fiscal year.
- Under the Point of Service Option, there is an outpatient
deductible of $300/individual and $600/family. - Non-network pharmacy use is subject to outpatient deductibles.
- This does not include the cost of care for the newborn
infant.
Click Here to read the (AAP) policy in reference to Family-Centered
Care
