TRICARE Plans
Maternity Care
TRICARE Standard provides servicemembers and their dependents with health care from authorized physicians on a fee-for-service basis. Minimum deductibles and copayments must be met before plan benefits begin.
Highlights
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Active duty servicemembers should receive their prenatal care from an obstetrician/gynecologist at a military treatment facility (MTF). If one is not available, the servicemember will be allowed to visit a civilian provider. Childbirths will take place at civilian hospitals.
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Women who are voluntarily discharged from active duty due to their pregnancy loose their TRICARE benefits for themselves and their family members. They may, however, receive benefits through the Continued Health Care Benefits Program or receive care at a military treatment facility that has obstetrical services if space is available.
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Pregnant active duty servicemembers who are involuntarily separated or the pregnant spouses of servicemembers who are involuntarily separated are entitled to care under the Transitional Assistance Management Program (TAMP).
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Often obstetrical care is not be available at a local military treatment facility. In this event, TRICARE Prime beneficiaries will be referred to TRICARE authorized civilian doctors.
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TRICARE Standard and TRICARE Extra beneficiaries can use any TRICARE-approved physician with applicable cost-shares and deductibles. Using TRICARE Extra can provide extra savings.
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Maternity care deductibles are waived for the dependents of Reserve Component members serving in active duty.
Drawbacks
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TRICARE recommends that expectant mothers enrolled in TRICARE Prime use their local military treatment facility if obstetric care is available. There are several drawbacks to not opting to use a military treatment facility.
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Servicemembers E-5 and above who dis-enroll from TRICARE Prime to use a non-MTF obstetrician through TRICARE Standard or another program cannot re-enroll in TRICARE Prime for 12-months.
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Many military treatment facilities only have space-available for TRICARE Prime beneficiaries.
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Certain types of sonograms (ultrasounds) are not covered by TRICARE. A sonogram must be deemed medically necessary by the attending physician. Any sonogram performed to determine the sex of a fetus is not covered.
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TRICARE Prime provides a point-of-service option for expectant mothers to obtain maternity care through any TRICARE authorized provider, in lieu of using a TRICARE network. This option can get expensive, as beneficiaries will have a 50% cost-share and a $300 deductible for individuals and a $600 deductible for families.
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TRICARE does not cover health care for the grandchildren of TRICARE eligible servicemembers. While the prenatal care of the eligible daughter of a servicemember is covered under TRICARE, her baby will not have insurance coverage after it is born, unless the sponsoring servicemember becomes the child's legal guardian.
