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Model Policy: Payer Coverage of Breastfeeding Support and
Counseling Services, Pumps and Supplies

The Patient Protection and Affordable Care Act (ACA) – the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010 – helps make preventive health affordable and accessible for all Americans by requiring health plans to cover preventive services and eliminating cost sharing for those services. Preventive services that have strong scientific evidence of their health benefits must be covered, and plans can no longer charge a patient a copayment, coinsurance, or deductible for these services when delivered by a network provider.

The United States Breastfeeding Committee (USBC) is pleased that the ACA requires coverage of preventive health services for women, including “breastfeeding support, supplies, and counseling,” further defined as “comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment.” These preventive services must be covered in conjunction with each birth, beginning in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012.

In the rapidly-changing landscape of insurance requirements under the ACA, few guidelines or recommendations existed as to who may provide and be reimbursed for lactation care, and what kinds of equipment should be covered for breastfeeding families. This model policy was created in partnership with the National Breastfeeding Center to identify best practices for supporting coverage of services, pumps and supplies appropriately.

Download the Model Policy (2nd revised edition)

Cover Letter

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