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

Background

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. Therefore, a model policy was developed to guide payers with best practices for structuring coverage of services, pumps, and supplies in their benefit plans.

Note: As of May 2, 2016, the Model Policy: Payer Coverage of Breastfeeding Support and Counseling Services, Pumps and Supplies is no longer a publication of the United States Breastfeeding Committee. To find the most current version of this document, please visit the National Breastfeeding Center.