Blue Cross and Blue Shield of Illinois

 

 

May 24, 2013

Legislative Update
Update Regarding Electric Breast Pump Coverage

As previously communicated, effective April 15, 2013, Blue Cross and Blue Shield of Illinois expanded 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.

This communication outlines the updated information regarding the limits and restrictions. 

Pump Type

Coverage Level

Qualifying Source

Limits/Restrictions

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 benefit period

Coverage is the cost up to the purchase price ($125-$150)

Hospital Grade Breast Pump
E0604

100% – no cost-share
Rental only
(see limit/restriction)

In-Network or contracted DME supplier

Hospital grade pump only available for monthly DME rental.

Coverage is up to the purchase price of $1,000 or 12 months whichever comes first. Upon end of coverage, unit must be returned to DME provider.

Breast Pump Supplies A4281-A4286 are covered at 100% without cost-sharing.

 

 
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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.