Premera Blue Cross, a leading health insurance provider in Washington and Alaska, offers comprehensive breast pump coverage as part of its commitment to supporting maternal health. This guide provides detailed information on the types of breast pumps covered, eligibility criteria, and the process for obtaining a breast pump through your Premera plan.
Types of Breast Pumps Covered
Premera covers various types of breast pumps to accommodate different needs:
- Manual Pumps: Operated by hand, suitable for occasional use.
- Battery-Operated Pumps: Portable and convenient for infrequent pumping.
- Electric Pumps: Ideal for regular use, available in single or double options.
- Hospital-Grade Pumps: High-powered, double electric pumps intended for multiple users with personal accessory kits. Available for rental only.
Coverage includes the purchase of one over-the-counter pump or the rental of one hospital-grade pump per calendar year. Members cannot both purchase and rent a pump within the same year. The rental of the Medela Symphony hospital-grade pump is covered at 100% of the allowed amount.
Coverage Details
Coverage specifics may vary based on your plan:
- In-Network Providers: Purchases or rentals through in-network providers are typically covered at 100%.
- Out-of-Network Providers: Purchases may be reimbursed up to a certain amount (e.g., $300), subject to plan allowances.
- Supplies: Essential supplies like tubing, flanges, breast shields, valves, and storage containers are covered. Items such as totes, ice packs, cooler bags, extra batteries, or extra bottles are not covered.
- Prior Authorization: Not required for obtaining a breast pump or supplies.
How to Obtain a Breast Pump
- Determine Eligibility: Confirm your eligibility by reviewing your plan details or contacting Premera customer service.
- Select a Provider: Choose an in-network provider from Premera’s list of approved vendors.
- Place an Order: Order your breast pump through the selected provider. If purchasing out-of-network, retain the receipt for reimbursement.
- Submit Claims: For out-of-network purchases, complete the Claim Reimbursement Request form and submit it along with the detailed receipt to Premera.
Lactation Counseling Services
Premera also covers lactation counseling services:
- In-Network Visits: Typically covered at 100% for the first 12 visits per calendar year.
- Out-of-Network Visits: May be reimbursed up to a certain percentage of the allowed amount, depending on the plan.
- No Prior Authorization: Required for lactation counseling services.
These services include assistance with latching difficulties, sore nipples, low milk supply, and other breastfeeding challenges.
Additional Resources
- Premera Pregnancy Support: Premera Pregnancy Resources
- Breast Pump and Lactation Counseling Tip Sheet: Premera Tip Sheet PDF
- Customer Service: Call the number on the back of your Premera ID card for personalized assistance.