Maternity care

Maternity care includes medical services related to prenatal care, labor and delivery and postpartum care.

Eligibility

  • TRICARE covers maternity care for a TRICARE-eligible dependent daughter of an ADSM or retired service member
  • TRICARE does not cover care for the newborn grandchild unless the newborn is otherwise eligible as an adopted child or the child of another eligible sponsor.
  • A newborn is covered as a TRICARE Prime or TPR beneficiary for the first 90 days following birth or adoption as long as one additional family member is enrolled in TRICARE Prime or TPR. If the child is not enrolled in TRICARE Prime, TPR or TRICARE Select within 90 days, coverage outside of the Direct Care system is forfeited.

Coverage

  • Maternity care includes medical services related to prenatal care, labor and delivery and postpartum care.
  • TRICARE covers professional and technical components of medically necessary fetal ultrasounds as well as the maternity global fee.
  • A maternal ultrasound is covered only with diagnosis and management of conditions that constitute a high-risk pregnancy.
  • TRICARE does not cover ultrasounds for routine screening or to determine the sex of the baby.
  • A maternity emergency-defined as a sudden unexpected medical complication which puts the mother, or fetus, at risk.

Referral and authorization requirements

TRICARE Prime:

  • The TRICARE Prime PCM for a beneficiary who becomes pregnant must submit a referral request prior to the mother’s first pregnancy-related appointment for global OB care.
  • The approved referral for global OB care begins with the first prenatal visit and remains valid until 42 days after birth and includes the hospital admission for a routine delivery.
  • Hospitals are required to notify Humana Military of preterm admissions.

Active Duty:

  • Require an approved referral for global OB care prior to the first pregnancy related appointment for global OB care.
  • Hospitals are required to notify Humana Military of all admissions for active duty including the routine delivery.

TRICARE Select or Non-Prime admissions:

  • Do not require a global OB referral or authorization for an admission for a routine delivery.

TRICARE PRIME, active duty and TRICARE Reserve Select:

  • TRICARE allows a hospital length of stay of up to 48 hours following a normal vaginal delivery or 96 hours following a cesarean section.
  • Notify Humana Military if the mother is hospitalized for a preterm admission or placed in observation during the pregnancy for any reason other than delivery.
  • If a newborn remains in the hospital after the mother is discharged, a separate inpatient authorization is required for the newborn.