OCTOBER 4, 2024 – Are you expecting a baby in 2025? Have you considered getting breastfeeding counseling or support from a labor doula?
If so, you should know about some changes coming to the TRICARE Childbirth and Breastfeeding Support Demonstration on Jan. 1, 2025. This demonstration provides childbirth and breastfeeding support services to those who have TRICARE Prime, TRICARE Prime Remote, or TRICARE Select. In 2025, the CBSD will expand overseas. There are also some new certification and participation requirements for labor doulas in the United States.
“These changes are built into the five-year demonstration. This helps us understand how these providers support our pregnant beneficiaries,” explained Erica Ferron, management and program analyst, TRICARE Health Plan, at the Defense Health Agency. “We believe the expanded demonstration will help us serve the needs of our military parents and children across the world.”
In 2025, the CBSD will still include services from these TRICARE-authorized providers:
- Certified labor doulas
- Certified lactation consultants
- Certified lactation counselors
Keep reading to learn more about what’s changing—and what’s staying the same—in the CBSD in 2025.
Changes in the U.S.
Here are the key changes to childbirth support in the U.S. beginning Jan. 1:
- Participation agreements: Certified labor doulas in the U.S. must sign a participation agreement to take part in the CBSD. Are you pregnant now and expect to give birth in 2025? Ask your labor doula if they’ve signed a participation agreement with your regional contractor. If they haven’t, you’ll have to pay the full cost of services received on or after Jan. 1. Labor doulas with a participation agreement can’t ask you to pay for covered services once you’ve met your deductible. They also can’t ask you to file your own claims. (Note: If you’re in the West Region, your contractor is Health Net Federal Services, LLC through Dec. 31. Beginning Jan. 1, 2025, it’ll be TriWest Healthcare Alliance.)
- Certification requirements: Among other qualifications, labor doulas must have a current certification from an approved certifying body. As of April 11, 2024, the list of approved certifying bodies included the National Black Doulas Association. (Note: Labor doulas working with a state Medicaid program may not be required to meet the certification requirement. But they must still sign a participation agreement.)
- Visit flexibility: The CBSD now includes a maximum of six hours of visits from your labor doula. These can happen before or after you give birth. The six hours can be split into 15-minute increments any way you’d like. The CBSD also covers labor support during the birthing event. There isn’t a time limit on this support.
Expansion overseas
The CBSD expands overseas and to U.S. territories Jan. 1, 2025. The TRICARE overseas regional contractor is International SOS.
However, the CBSD works differently than it does in the U.S. Here’s what to know and do.
1. Check if you’re eligible
To be eligible for the CBSD, you must:
- Have TRICARE Prime, TRICARE Prime Remote, or TRICARE Select.
- Plan to give birth outside a military hospital or clinic and be 20 weeks pregnant to get childbirth support.
- Be 27 weeks pregnant to get breastfeeding support.
2. Register
Overseas, you must register for the CBSD before you get any services. You can sign up starting Oct. 3. To register, contact International SOS via phone or email. You’ll get an email with information about the CBSD if you live overseas and get an inpatient authorization for obstetric care.
You should register as early as possible in your pregnancy. After you register, International SOS will let you know if they can find a TRICARE-authorized provider within 14 days.
3. Find covered providers
Work with International SOS to find a labor doula or lactation consultant or counselor. This will help make sure that TRICARE covers your provider’s services.
Overseas, labor doulas don’t need to sign a participation agreement. But they must still meet certain qualifications. Countries with the most overseas births will include CBSD providers in searchable provider directories. This will help you find covered providers.
It’s important to know that TRICARE can’t guarantee CBSD services overseas. International SOS will try to find a provider for every eligible and interested beneficiary, but it may not always be possible.
Note: You shouldn’t enter into a contractual agreement with a labor doula before International SOS confirms that TRICARE will cover their services. If you do, you may need to pay the full cost of those services.
You should also ask about any country-specific restrictions on a provider’s services. For example, some countries don’t allow labor doulas in the delivery room.
4. Know what’s covered
The CBSD overseas includes the same benefits as it does in the U.S. These are:
- Six total hours of labor doula support, before or after you give birth. The CBSD also includes unlimited hours of labor support during one birthing event.
- Six total sessions of breastfeeding support per birthing event. These sessions are already a covered TRICARE benefit, as described in the TRICARE Maternity Care Brochure. But now, you can get these services from lactation consultants or lactation counselors. These can be group or individual sessions.
5. Know what’s not covered
The CBSD doesn’t cover:
- Telehealth labor doula services. (You can get telehealth breastfeeding support via two-way video, if you and your provider are in the same country.)
- CBSD services received overseas before Jan. 1, 2025
- Services received at a military hospital or clinic
Moving during your pregnancy
Do you think you may move to or from the U.S. during your pregnancy? If so, there are a few more things to keep in mind. If you’re moving:
- From the U.S. to overseas: Contact International SOS, even if you aren’t yet enrolled in your overseas plan. You can do this as soon as you know you’ll be moving overseas. You may not yet be able to register in the CBSD overseas, but you can see if providers are available. You’ll need to register for the CBSD once you’re enrolled with International SOS, before you get services.
- From overseas to the U.S.: If you’re enrolled with International SOS but planning to deliver in the U.S., you’ll still need to register for the CBSD with International SOS. Then, you can search U.S. networks and use providers participating with the U.S. regional contractors.
The CBSD ends in the U.S. and overseas Dec. 31, 2026. At this time, TRICARE will decide if this coverage will become permanent.
Want to unlock your health by learning more about the CBSD? Check out Childbirth and Breastfeeding Support Demonstration, or contact your regional contractor for more information.
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Courtesy Story
Defense Health Agency