There are many parts of the Affordable Care Act (ACA), but one of the most valuable is that ACA requires health plans to cover breastfeeding support and supplies. Priority Partners will cover breast pumps and pump kits for infants using these guidelines.

First Month of Life for Infant:

Priority Partners will cover breast pumps and pump kits under the conditions listed below:

  • If baby or mother are hospitalized.  If baby is in the Neonatal Intensive Care Unit (NICU) longer than a month, Priority Partners would continue providing pump during NICU stay.
  • If mom is temporarily given medications that will make it so she can’t breastfeed (“pump and dump”).
  • If baby is unable to nurse fully for reasons such as a baby born more than 3 weeks before the due date or problems with being able to “latch on.”
  • If mother had underdeveloped breasts or breast surgery, needing a hospital-grade electric pump to help start full milk supply.
  • If mother is going back to work before baby is one month of age.

The Breast Pump can be a hospital grade double electric pump or a high quality non-hospital grade double electric pump.

After First Month of Life for Infant:

  • Priority Partners to cover non-hospital grade pump for reasons that make a breast pump medically necessary.
  • Priority Partners does not need to provide a breast pump after first month of life for non-medical reason, including mom’s return to work.
  • Priority Partners may not require a denial from Women, Infants and Children (WIC) prior to approving breast pumps.

If you need more information or have questions, call Priority Partners Customer Service at 1-800-654-9728.