April 19, 2013 Legislative Update BCBSIL’s Implementation of ACA Women’s Preventive Services Now Includes Coverage for Electric Breast Pumps Effective April 15, 2013, Blue Cross and Blue Shield of Illinois (BCBSIL) is expanding its implementation of preventive services under the Affordable Care Act (ACA) to include coverage for electric and hospital grade breast pumps. This coverage applies to non-grandfathered plans and policies, and expands the breastfeeding support options available to members without cost-sharing. Pump Type | Coverage Level | Qualifying Source | Limit/Restriction | Manual Breast Pump E0602 | 100% – no cost-share | In-Network, Out of Network, Retail | N/A | Electric Breast Pump E0603 | 100% – no cost-share | In-Network Provider or contracted Durable Medical Equipment (DME) supplier only | Two per calendar year | Hospital Grade Breast Pump E0604 | 100% – no cost-share Rental Only (see limit/restriction) | In-Network or contracted DME supplier* | Coverage is the rental cost up to the purchase price ($125-$150) *standard process for DME rental equipment applies – monthly rental costs should not cumulatively exceed purchase price. Hospital grade pump available for rental only at this time. | Breast Pump Supplies A4281-A4286 are covered at 100% without cost-sharing. | Note: Grandfathered groups that have previously included coverage for pumps will not be impacted by this change. Please contact your BCBSIL representative if you have questions regarding this information. |