Reproductive Health Coverage 101

May 9, 2021

Whether you’re currently pregnant, recently had a baby, are trying to conceive, or it’s not the right time for you to have a baby, reproductive healthcare and coverage can be complicated. At Blue KC, we know you have several options for care and believe it’s our job to help our members determine what may be best for their care needs.

This blog post will explain what you should know about coverage for reproductive healthcare, as well as common misconceptions about reproductive health and insurance.

Pre- and Perinatal Care

Pregnancy and birth can be such an exciting time for a woman and her family and friends. At the same time, however, it can be very overwhelming or even isolating.

Blue KC has a team of specialists called Care Managers who work to make our members’ care accessible and affordable. We like to think of Care Managers as special patient advocates who provide personalized care and attention every step of the way through a member’s healthcare journey.

Julie Ham, Blue KC Director of Care Management, with her family.

Two of these Care Managers, Julie Ham and Mallorie Tener, specialize in maternal and neonatal care and enjoy making regular connections with members on the phone, via email and even instant message to help them through their respective journeys. Blue KC’s care management mobile app, created in partnership with Wellframe, puts members in control of their health by connecting them directly with care managers including Mallorie and other members of Julie’s team. If you have questions about your coverage, symptoms, or anything else you might be curious about, the team is just a message away – like a pep talk in an app, explained Mallorie. You can also reach our Care Management team by calling the number on the back of your member ID card.

Postpartum Care

So, you’ve given birth, set up the nursery, picked out a name, are receiving dozens of congratulatory calls and messages from family, friends and colleagues (and maybe even people you don’t even know!). It’s an extremely exciting time but it doesn’t come without a few challenges, especially if it’s your first child. We’ve all seen the movies, read the books, or viewed social media posts with the seemingly perfect postpartum experience. But, it’s important to remember that each person may have a completely different experience and it’s okay, even normal, to feel overwhelmed with emotion – sad, happy, tired, stressed. Motherhood may not be what you think it’s going to be, and that’s okay.

For example, breastfeeding can be much more challenging than what’s commonly depicted in pop culture and on social media.

“Breastfeeding is very difficult. It’s an actual job, but then you see the pictures of it being easy – women who are showered, have their hair brushed and make-up done and are breastfeeding their babies with a smile. Realistically, that’s not likely what’s going to happen at your house at first,” Mallorie said. “It’s important to be patient with yourself and your baby while you learn to navigate your new normal.”

Many plans include lactation coverage, which allow new parents to purchase breast pumps and give them access to resources such as lactation consultants. If you have a Flexible Spending Account (FSA), you can use to purchase FSA-compliant items directly.

Most plans include preventive coverage, which allow new parents the option of a fully covered breast pump through insurance or the option of a different breast pump for an upgrade charge. If you have an HSA or FSA, these can typically be utilized in helping with any upgrade charge for a breast pump or extra breast pump parts needed. To find out what items are FSA-compliant, you can use Many plans include lactation support coverage for members to access resources such as lactation consultants.

Blue KC also offers behavioral health support to new mothers. Postpartum depression and anxiety are very common – the CDC reports that 1 in 10 new mothers struggle with their behavioral health following birth. It’s also important to know symptoms of postpartum depression and anxiety manifest differently in everyone. If you believe you may be struggling, you have support and you are not alone.

Mindful by Blue KC, our suite of behavioral health services launched last year to help all members, including new parents, find the care best suited for their needs. Our Mindful Advocates can help you find the resources you need to feel better and take charge of your behavioral health. To speak with a Mindful Advocate, call 833-303-MIND (6463) or call the behavioral health number on your member ID card.

Infertility Treatment

If you’re trying to become pregnant and are having difficulty, it’s important to know you’re not alone – 15 percent of couples struggle to conceive. Infertility can be an isolating experience, but it doesn’t have to be. Our care managers can support you by identifying steps you can take with your OBGYN to determine your treatment options. They can also work with you to identify and explain your coverage for various treatments.

Maternal Health

The social determinants of health are a crucial piece of maternal health, and we are committed to reducing inequities and disparities in maternal health in partnership with the Blue Cross Blue Shield Association and its other member companies. Contributing factors to maternal health include economic status, ethnicity/race, education, maternal age (35 is considered advanced maternal age), history of complications or chronic health conditions and others. At Blue KC, we leverage a social determinants of health questionnaire to help identify patients that may need additional resources.

A real-life example: Mallorie noticed that one of her patients who had recently delivered triplets prematurely was admitted to the hospital with a high fever. At the time, Mallorie was regularly checking in on the health of infants. When she noticed their mother had been admitted to the hospital, she immediately called to see how the woman and her family were holding up, especially since they also had a 1-year-old at home. The answer: they were overwhelmed and financially strained. Mallorie and her team were able to offer access to resources, including connections to organizations that helped the family pay for their utilities and other expenses, and the mother and her babies were eventually discharged with clean bills of health.

Blue KC Care Manager Mallorie Tener with her son.

“We do truly care about them,” Mallorie said. “We want them to stay healthy, informed, and utilize their insurance the best way possible so they don’t feel duped by their insurer or provider. We want thriving moms and babies.” 


Contraception is an important part of your reproductive health journey, too. Under the Affordable Care Act, birth control treatments, such as the pill, are included in your plan at no out-of-pocket cost to you if they are approved by the FDA and prescribed to you by a doctor. According to the FDA, approved treatments include:

  • Barrier methods, like diaphragms and sponges
  • Hormonal methods, like birth control pills and vaginal rings
  • Implanted devices, like intrauterine devices (IUDs)
  • Emergency contraception, like Plan B® and ella®
  • Sterilization procedures
  • Patient education and counseling

Exceptions exist, however, and not every type of birth control is covered under every plan or by every employer, such as those with certain religious affiliations. Make sure to verify your coverage for contraceptive care with your employer’s benefits manager before making a decision about your birth control. Of course, our Care Managers are also available to discuss this with you.

What Else to Know about Your Coverage

Coverage for reproductive healthcare can vary across plans, so we recommend exploring your benefits to find out exactly what’s covered for you. You can use the Blue KC member portal, to access your medical certificate which includes all the details about your coverage. If you’re confused about what’s explained in the medical certificate, you can connect with a Blue KC Care Manager or customer service representative who can clarify what the information means.  If something you need or want – such as a birthing class – isn’t included in your plan, our Care Managers can work with you to help find an option that fits your needs, like free or virtual classes.

Moreover, if you’re a Blue KC member with the Preferred Care Blue Plan, you also have the entire Blue Cross Blue Shield network behind you. We will always work to help connect you providers you may have access to as part of your coverage with Blue KC, regardless of whether you live in Kansas City or not.

It’s our goal to be here for all your healthcare needs. If you have additional questions about reproductive healthcare or anything else related to your coverage, visit or connect with a Care Manager today.