Having a baby in the Untied States is extremely costly. If you have health coverage like CHAMPVA, it can make a big difference in how much you have to pay. What medical services relating to pregnancy and childbirth are covered by CHAMPVA?
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The CHAMPVA Handbook lists a sampling of covered and non-covered services and supplies. Please note that what is in the handbook is not all-inclusive, nor is it the final word. If you are not sure, contact CHAMPVA directly and ask if a service or supply you need is covered or not. Bear in mind that the VA will share in the cost only for matters that are deemed “medically necessary” and performed or given by qualified persons.
Pregnancy and Maternity Services Covered by CHAMPVA
The following are some of the services covered by CHAMPVA as listed in the CHAMPVA Handbook, and under what circumstances they will be covered. This is not the official word and policies can change. Contact CHAMPVA to verify.
Birth Control Methods
Coverage is available for various types of contraception such as IUD’s, sterilization, diaphragms, pills, etc. See the CHAMPVA Handbook.
Outpatient birthing rooms that are based in a hospital are covered as ambulatory surgery. This includes an expected normal delivery and maternity care for a normal pregnancy.
As stated in the CHAMPVA policy manual, hospital-grade electric breast pumps are covered only when medically necessary for premature babies, and then only in two specific circumstances:
- During the premature baby’s postpartum stay in the hospital;
- When the baby goes home and the doctor explains why continued use of a pump is medically necessary
The use of breast pumps solely for the mother’s convenience are emphatically not covered. Also other types of pumps such as manual and simple electric pumps are excluded.
Special note for c-sections: According to the CHAMPVA Policy Manual, c-sections are covered where “medically necessary.” However what’s known as “elective cesarean” (that is, requested for convenience by the patient) has only limited coverage. CHAMPVA will answer for it the same way as for vaginal delivery. The beneficiary is responsible for charges in excess of this.
In general, CHAMPVA will cover services relating to prenatal, postnatal and childbirth care. This includes special circumstances such as miscarriage and preterm labor. Treatments given to mother and infant should be billed separately. However, a newborn child is initially covered by the mother’s own health coverage.
To avoid problems, claim a newborn child as a dependent with your VA Regional Office to add him or her to your list of dependents. This will not only increase your VA disability compensation (since only 100% and P&T IU veterans are eligible to sponsor their families for CHAMPVA), but it will also allow you to claim the child as another CHAMPVA beneficiary.
CHAMPVA will cover genetic testing during a pregnancy if any of the following applies:
- The woman is age 35 or older
- One parent has had a child with a congenital abnormality, or a history of the same in his/her family
- The mother had rubella during the first trimester of the pregnancy
- There is a history of recessive genetic disorder or cystic fibrosis
An AIDS virus test during pregnancy is covered. HIV testing is also covered if the patient has been exposed to the virus or shows symptoms of the disease.
Vaccines at appropriate times and situations as advised by your doctor are covered.
Newborn Child Care
Newborn babies are covered by the mother’s own CHAMPVA benefits for the first 3 days of life. Beyond this, the child must have its own cost share.
It’s important to get your child’s state-issued birth certificate and Social Security Number as soon as possible, so you can claim him or her as a dependent of your VA benefits. Once claimed as a dependent in your VA compensation, you can also claim the baby as a CHAMPVA beneficiary. For instructions, contact your VA Regional Office.
CHAMPVA will cover ultrasound during pregnancy only in limited circumstances, namely for high-risk pregnancies or when there is a likelihood of newborn complications.
Standard well-child checkups are covered up until a child is 6 years old.
Non-Covered Services Relating to Pregnancy
Abortion and Abortion Counseling
Abortion is not covered except when it is established that the mother’s life will be in danger if she carries the pregnancy to term. A qualified physician must certify this to be fact.
Artificial Insemination and In Vitro Fertilization
These methods of fertilization are not covered by the program.
Gender Testing and Paternity Testing
Tests done to find out the sex or paternity of an unborn child are not considered “medically necessary” so they are not covered.
Postpartum Inpatient Stay
CHAMPVA will not cover for inpatient stay that is solely for the sake of one person staying with the other. Suppose you give birth and are ready to be discharged, but your baby has to stay in intensive care. If you receive inpatient care just so you can stay with your baby, your care is not covered.
Likewise, if it is the mother who needs continued treatment but the baby is fine, the baby’s stay with the mother will not be covered inpatient care.