The memorandum directed the to take a series of actions to ensure Service members and their families can access reproductive health care; DOD health care providers can operate effectively, consistent with federal law; and to establish uniform policies to protect the privacy of reproductive health information. Those directed policies were released on Feb. 16, 2023.

This policy standardizes and extends the timeframe for Service members to inform their commanders about a pregnancy.  Service members may now choose to delay command notification of a pregnancy until no later than the 20th week of pregnancy, except in certain circumstances. Learn More

Service members will be provided the time and flexibility to make private health care decisions in a manner consistent with the responsibility of commanders to meet operational requirements and protect the health and safety of those in their care. Service members who delay sharing their pregnancy status with their commanders will be placed on a limited duty status (as appropriate), as recommended by their treating health care provider. Additionally, there are some exceptions that may apply, based upon individual circumstances of the Service member, a potential upcoming deployment, or unit hazards. These safeguards balance Service member desire for privacy with their health and well-being, as well as unit and mission needs. Learn More

DOD providers must have a "good faith" belief that the patient is a victim of rape or incest to perform the abortion. Service members are not required to make a formal report or engage with the Sexual Assault Prevention and Response Program or Family Advocacy Program (FAP) to be eligible for an abortion, although providers are still required to notify the Sexual Assault Response Coordinator (SARC) or FAP that they are treating a patient who reports they are a victim of sexual assault, so that the SARC or FAP can inform the victim of services and reporting options. FAP clinicians are required to report suspected child abuse/child sexual abuse directly to local civilian child welfare services. There is no requirement that the health care provider inform the SARC or FAP that the patient requested an abortion. DOD providers should engage MTF legal counsel and MTF leadership, as well as subject matter experts within SAPR Program or FAP, if there are concerns about making a "good faith" belief determination. However, providers must not attempt to gain information from other sources in making their good faith determination (other than a consultation with SMEs as noted above) or compromise an adult patient's reporting options by notifying the chain of command, or law enforcement, unless otherwise indicated in DODI 6310.09 or advised by MTF legal counsel.

Commanders must protect the privacy of protected health information, and information shall be restricted to personnel with a specific need to know.

No. Any DOD personnel required to make mandatory notifications, such as those related to domestic abuse or sexual assault, in accordance with application DOD or Military Department/Service regulations, must do so. However, those required notifications must be done without disclosing the Service member’s pregnancy status.

There are military duties, occupational health hazards, and medical conditions where the proper execution of the military mission outweighs the interests served by delaying commander notification of a pregnancy. If the DOD health care provider makes the notification to a commander, the Service member will be notified prior to the command notification except in exigent circumstances. A commander will be notified of a pregnancy prior to the 20^th week if:

• The Service member is in a position pre-identified by Military Department/Service regulations as having mission responsibilities or being subject to occupational health hazards that would significantly risk mission accomplishment.
• The treating DOD health care provider has determined that there are special medical circumstances that require earlier notification.
• There are other special circumstances, determined on a case-by-case basis by a DOD health care provider, where the military mission outweighs the interests served by delaying notification.

Health care providers may only disclose information to commanders in specific circumstances, such as when the Service member’s duties will adversely impact the health and well-being of the Service member and the pregnancy. Health care providers will be required to discuss risks with Service members and recommend a limited duty status for all Service members opting to delay their notification, unless an exception applies. If the DOD health care provider makes the notification to a commander, the Service member will be notified prior to the command notification except in exigent circumstances. To address whether the Service member’s preference to delay notification is possible, health care providers will discuss risks with Service members who may be adversely impacted if they delay notification.

For the purposes of these policies, ART includes:

• Ovarian stimulation and egg retrieval, including any needed medications and procedures required for retrieval, processing and utilization for ART or cryopreservation
• Sperm collection and processing for ART or cryopreservation
• Intrauterine insemination (IUI)
• In vitro fertilization (IVF) inclusive of the following procedures for beneficiaries when clinically indicated:
  • In vitro fertilization with fresh embryo transfer
  • Gamete intrafallopian transfer (GIFT)
  • Zygote intrafallopian transfer (ZIFT)
  • Pronuclear stage tubal transfer (PROST)
  • Tubal embryo transfer (TET)
  • Frozen embryo transfer

Service members may be granted an administrative absence from their normal duty station, without being charged leave, for a period of up to 21 days to receive, or to accompany a dual-military spouse or dependent who receives, non-covered reproductive health care.

Non-covered reproductive health care is defined in policy as lawfully available assisted reproductive technology, which includes egg retrieval, IUI, and IVF, and non-covered abortion. Non-covered reproductive health care is at the patient’s expense.

More information on this policy is available at: www.health.mil/EnsuringAccesstoReproductiveHealth.

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The Department of Defense defines a covered abortion is an abortion, either medical or surgical, where the life of the mother would be endangered if the fetus were carried to term or in a case in which the pregnancy is the result of an act of rape or incest.

A non-covered abortion is an abortion, either medical or surgical, that does not meet the criteria of a covered abortion.

Active duty Service members, including Reserve or National Guard members when on active duty orders for 30 or more consecutive days, may request an administrative absence to access non-covered reproductive health care, or accompany a dependent to access non-covered reproductive health care.

An administrative absence can be requested when a Service member needs to access, or accompany a dependent to access, non-covered reproductive health care so that they do not need to use chargeable leave. Service members who are already accessing ART through the Supplemental Health Care Program are not eligible as they are able to receive such care without using chargeable leave.

It is the responsibility of Commanders or approval authorities to meet operational requirements and protect the health and safety of those in their care. Commanders or approval authorities are expected to display objectivity, compassion, and discretion when addressing all health care matters, including reproductive health care matters, and have a duty to enforce existing policies against discrimination and retaliation in the context of reproductive health care choices.

Commanders or approval authorities must act promptly when considering a Service member’s request for an administrative absence to access non-covered reproductive health care, with due regard to the time-sensitive nature of many non-covered reproductive health care services. Requests for administrative absence should be given all due consideration and should be granted to the greatest extent practicable unless, in the commanding officer’s judgment, the Service member’s absence would impair proper execution of the military mission.

Commanders or approval authorities will not levy additional requirements on the eligible Service member (including, but not limited to, consultations with a chaplain, medical testing, or other forms of counseling) prior to approving or denying the administrative absence request.

Commanders must protect the privacy of protected health information, and information shall be restricted to personnel with a specific need to know.

Yes. Service members on Active Duty may choose to request regular leave or special liberty instead of an administrative absence to access non-covered reproductive health care. Special liberty would be limited to no more than 4 days.

Service members are already authorized to receive covered abortions and do not need to be in a leave or liberty status in order to access this care.

Service members who are eligible for a covered abortion may seek care at their local military medical treatment facility. Existing processes exist to fund travel for Service members who must receive covered care outside the local area.

No. Service members will not be granted an administrative absence to access non-covered reproductive health care if the intent is to sell, offer for sale, or receive proceeds from a sale resulting from an ART procedure.

Service members whose requests for an administrative absence to access non-covered reproductive health care are denied may appeal their request in accordance with applicable Military Service policy.

The Department of Defense defines a covered abortion is an abortion, either medical or surgical, where the life of the mother would be endangered if the fetus were carried to term or in a case in which the pregnancy is the result of an act of rape or incest.

A non-covered abortion is an abortion, either medical or surgical, that does not meet the criteria of a covered abortion.

For the purposes of these policies, ART includes:

• Ovarian stimulation and egg retrieval, including any needed medications and procedures required for retrieval, processing and utilization for ART or cryopreservation
• Sperm collection and processing for ART or cryopreservation
• Intrauterine insemination (IUI)
• In vitro fertilization (IVF) inclusive of the following procedures for beneficiaries when clinically indicated:
  • In vitro fertilization with fresh embryo transfer
  • Gamete intrafallopian transfer (GIFT)
  • Zygote intrafallopian transfer (ZIFT)
  • Pronuclear stage tubal transfer (PROST)
  • Tubal embryo transfer (TET)
  • Frozen embryo transfer

Service members and eligible dependents may be authorized travel and transportation allowances to access non-covered reproductive health care services when timely access to non-covered reproductive health care services is not available within the local area of the member’s permanent duty station, temporary duty location, or the last location the dependent was transported on authorized government orders.

Non-covered reproductive health care is defined in policy as lawfully available assisted reproductive technology and non-covered abortion. Non-covered reproductive health care is at the patient’s expense.

More information on this policy is available at: www.health.mil/EnsuringAccesstoReproductiveHealth.

For non-covered ART, travel and transportation allowances for Service members (including Active Duty Service members and Reserve Component Service members on active duty orders for 180 days or more) and spouses of such Service members receiving care may be authorized when the non-covered ART procedure is substantiated in documentation by the licensed health care provider or clinic that will be performing the ART services. Funded travel can be requested by Service members for their own, or their spouse’s, care and may include a non-medical attendant to accompany either the Service member or spouse, when necessary. Substantiating documentation provided by the traveler to the approving official (AO) must include details of the procedures to be performed, dates of consultation appointments and/or procedures, and include any of the following: identification of a treatment plan schedule, medical diagnosis, and patient names to verify eligibility. The non-covered reproductive health care is at the patient’s expense.

For non-covered abortion, travel and transportation allowances for Service members (Active Duty Service members, Reserve Component Service members on active duty orders for more than 30 consecutive days, and Service academy cadets and midshipmen) and dependents of such Service members receiving care may be authorized when a licensed medical provider has validated the pregnancy and substantiating documentation is provided. Funded travel can be requested by Service members for their own, or their dependent’s, care and may include a non-medical attendant to accompany either the Service member or dependent, when necessary. The non-covered reproductive health care is at the patient’s expense.

Service members may be authorized standard travel and transportation allowances as detailed in the Joint Travel Regulations par. 033001.

Eligible dependents and escorts may be authorized the actual cost of lodging, the actual cost of meals, and round-trip transportation between the Service member’s permanent duty station or last location the dependent was transported on authorized government orders and the non-covered reproductive health care service care location. The non-covered reproductive health care is at the patient’s expense.

Service members who are eligible for a covered abortion may seek care at their local military medical treatment facility and do not need to request travel and transportation allowances under this policy. Existing processes are in place to fund travel for Service members who must receive covered care outside the local area.

It is the responsibility of Commanders or approval authorities to meet operational requirements and protect the health and safety of those in their care. Commanders or approval authorities are expected to display objectivity, compassion, and discretion when addressing all health care matters, including reproductive health care matters, and have a duty to enforce existing policies against discrimination and retaliation in the context of reproductive health care choices.

Commanders must protect the privacy of protected health information, and information shall be restricted to personnel with a specific need to know.

Active duty Service members and their dependents are eligible to request and receive funded travel when non-covered reproductive health care services are not available locally.

Yes. For the Dependent Invitational Travel Order, certain conditions apply. Travel authorizations/vouchers are processed for the family member of a Service member. The sponsor can receive reimbursement for the dependent's transportation and approved travel expenses. Either the sponsor or a Defense Travel Administrator will assist with document processing as the dependent may have no access to DoD travel systems like the Defense Travel System or MyTravel.

Service members whose requests for travel and transportation allowances for non-covered reproductive health care may appeal their request in accordance with applicable Military Service policy.

Military and civilian health care providers working in military medical treatment facilities may request reimbursement to receive an alternate license when their current license is in a state where the provision of federally authorized health care is restricted.

Yes. DOD providers may continue to provide covered abortion services as part of their federal duties if medically appropriate, even if those services are prohibited by state law or licensing requirements. (A “covered abortion” is one DOD is authorized to perform under federal law, in cases where the life of the mother would be endangered if the fetus were carried to term, or where the pregnancy is the result of rape or incest.) 

Consistent with DOD Instruction 6025.27, “Medical Ethics in the Military Health System,” Nov. 8, 2017, providers who, as a matter of conscience or moral principle, do not wish to perform abortions are generally not required to do so.

Yes. Eligible DOD beneficiaries are encouraged to follow-up with their primary care manager or Women’s Health Provider following a pregnancy termination to obtain necessary follow-up care, to include convalescent leave (as indicated) or provision of contraception. This follow-up care is available regardless of whether the abortion service was a covered or non-covered procedure. Additionally, if a patient comes to a MTF with acute complications following a pregnancy termination, it is the duty of the receiving provider to care for these acute issues. By regulation, Active Duty Service members who experience complications resulting from a non- covered treatment also may be authorized for treatment in the private sector if necessary, consistent with applicable law.

DOD providers must have a “good faith” belief that the patient is a victim of rape or incest to perform the abortion. Service members are not required to make a formal report or engage with the Sexual Assault Prevention and Response Program or Family Advocacy Program (FAP) to be eligible for an abortion, although providers are still required to notify the Sexual Assault Response Coordinator (SARC) or FAP that they are treating a patient who reports they are a victim of sexual assault, so that the SARC or FAP can inform the victim of services and reporting options. There is no requirement that the health care provider inform the SARC or FAP that the patient requested an abortion. DOD providers should engage MTF legal counsel and MTF leadership, as well as subject matter experts within SAPR Program or FAP, if there are concerns about making a “good faith” belief determination.

However, providers must not attempt to gain information from other sources in making their good faith determination (other than a consultation with SMEs as noted above) or compromise an adult patient’s reporting options by notifying the chain of command, or law enforcement, unless otherwise indicated in DOD Instruction 6310.09 “Health Care Management for Patients Associated With a Sexual Assault,” May 7, 2019, or advised by MTF legal counsel.

Easy, convenient, and timely access to the full range of contraceptive methods and counseling is a goal of the Military Health System. To better facilitate access at military medical treatment facilities, the MHS has implemented walk-in contraceptive services at every MTF with appropriate clinical capabilities. These clinics do not require appointments and are staffed with health care personnel who are trained in the full range of contraceptive methods, including short-acting reversible contraceptives (e.g., birth control pill, patch, or ring) and Long Acting Reversible Contraceptives, such as intrauterine devices and implants.

To find the closest facility to you, please visit https://tricare.mil/WalkinContraceptiveServices.

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Cost-sharing amounts for prescription pharmaceuticals obtained outside a MTF, including oral contraceptive pills, are set in law, and would require a statutory change to waive. However, prescription pharmaceuticals are available to all eligible TRICARE beneficiaries in a MTF at no cost.

Co-pays have been removed for medical procedures associated with contraceptive care, such as placement of intrauterine devices, implants and female tubal sterilizationA surgical procedure that cuts the fallopian tubes out or ties them to permanently prevent pregnancy. tubal sterilization. 

DOD will continue providing IUDs and other contraceptive care in MTFs, consistent with federal law, regardless of state law restrictions.

Primary care providers who have been trained in placement (e.g., Family Medicine Physicians, Adolescent Medicine Physicians, Family Nurse Practitioners) and Women’s health providers (e.g., OB/GYN physicians, Women’s Health NPs, Certified Nurse Midwives) may place LARCs, as may other primary care providers who have been trained in placement (Family Medicine Physicians, Adolescent Medicine Physicians, Family NPs, etc.). In general, LARCs are provided during either an outpatient primary care, Certified Nurse Midwife, OB/GYN appointment, or less commonly, in a freestanding ambulatory surgery center or outpatient hospital department (e.g., when anesthesia is required). Beneficiaries outside an MTF may contact their Managed Care Support Contractor for assistance to locate a provider and navigating their plan.

Oral emergency contraceptives, such as Plan B and ella, are covered within DOD and by the TRICARE Pharmacy benefit. Plan B is available at MTF or network retail pharmacies without need for prescription and with no copay. Ella is available via prescription at MTF or network retail pharmacies (copay for non-Active Duty beneficiaries at retail only). For network retail pharmacies, the beneficiary (or a friend or partner picking up for the beneficiary) must provide documentation of patient identity and TRICARE eligibility, generally an appropriate ID card, in order for the pharmacy to process the TRICARE Pharmacy benefit claim. Plan B is also available for purchase in many Military Exchanges, pharmacies, and other local retailers.

DOD will continue to provide Plan B, ella, and other contraceptive care in MTFs, consistent with federal law, regardless of state law restrictions. If a state prohibited emergency contraceptives, we expect that private sector retail pharmacies operating in that state would comply with state law.

Currently, emergency contraceptives like Plan B or ella are not available via home delivery, given potential delays in receipt of medications via mail order. Home delivery utilization is best served for chronic conditions and not acute conditions where timing of medications, such as emergency contraceptive, is critical.

The DOD can perform or pay for abortion services for Service members, dependents, or other eligible DOD beneficiaries in certain circumstances. Consistent with federal law, this care is provided in cases where the life of the mother would be endangered should the fetus be carried to term, or in the case in which the pregnancy is the result of an act of rape or incest (described within DOD as “covered abortions”). Federal law prohibits the DOD from performing, or paying for the performance of, abortions for any other reason.

The Military Health System (MHS) has the capability to perform both medical abortions (which are performed with medication) and surgical abortions, in cases where the life of the mother would be endangered if the fetus were carried to term or in the case in which the pregnancy is the result of an act of rape or incest.

Yes, TRICARE will continue to pay for abortions for Service members, dependents, or other eligible DOD beneficiaries in cases where the life of the mother would be endangered should the fetus be carried to term or in the case in which the pregnancy is the result of an act of rape or incest (described as “covered abortions”). Private sector health care facilities are subject to the laws of the state where the care is provided. When state law restricts certain types of care, that care may no longer be available through private sector health care facilities in the local area.

However, military medical treatment facilities are still authorized to provide covered abortions, even when state laws restrict such care. When not available in the private sector, Service members and eligible beneficiaries may access care at a local military medical treatment facility or travel to the closest military medical treatment facility with the necessary capability. The following question outlines current processes for accessing covered care not available locally for beneficiaries. Beneficiaries seeking assistance with access to a covered abortion can contact https://health.mil/ContactUs, for assistance.

For a covered abortion, DOD provides the following travel and transportation allowances:

• Active Duty: Active Duty Service members (including Reserve Component Service members on Active Duty orders for a period greater than 30 days) who require authorized medically necessary care that is not available in their local area, including covered abortions, will be authorized to travel at government expense to receive the care. The Service member would need to provide their command with documentation from their medical provider indicating the need to travel for a necessary medical procedure. A description of the medical procedure would be contained in the individual’s medical records. The Service member would not be required to take leave for the travel.
• Other Beneficiaries:
  • TRICARE Prime: For non-Active Duty patients enrolled in TRICARE Prime, if the closest available care is more than 100 miles away from their primary care manager’s office, TRICARE may reimburse reasonable travel expenses for covered abortions in accordance with applicable rules and regulations.
  • TRICARE Select: For non-Active Duty patients enrolled in TRICARE Select, a referral will be made but there is no associated reimbursement for travel costs.
• Dependent Outside the Continental United States (OCONUS): Dependents accompanying Active Duty Service members (including Reserve Component members on Active Duty orders for a period greater than 30 days) stationed outside the Continental United States may be paid travel and transportation allowances to the nearest medical facility where a covered abortion could be performed. A written statement from a DOD medical authority must support the need for travel confirming both the seriousness of the condition and the absence of adequate military and civilian facilities for proper treatment.

DOD performs or pays for abortions for Service members, dependents, or other eligible DOD beneficiaries in cases where the life of the mother would be endangered should the fetus be carried to term or where the pregnancy is the result of an act of rape or incest (described as “covered abortions”). An eligible beneficiary can request a covered abortion from a MTF provider.

Patients may seek assistance from a Sexual Assault Response Coordinator (SARC), Sexual Assault Prevention and Response Victim Advocate (SAPR VA) or the Family Advocacy Program (FAP) who can connect them with the appropriate health care provider. They may also seek assistance through their primary care manager (PCM), a women’s health provider, or at an emergency room. MTFs either have providers who perform abortion services or have the ability to refer patients to an appropriate provider in the private sector or at another MTF.

Complete care generally includes an initial diagnosis of pregnancy, counseling regarding pregnancy options, any necessary pre-procedural evaluation, peri-operative care (care provided around the time of a surgical procedure), contraception counseling and provision, screening for sexually transmitted infections, referral for mental health services, and follow-up/post-operative care as required. Sexual Assault Response Coordinators (SARCs) or the Family Advocacy Program (FAP) are notified by a DOD medical provider at an MTF if a patient informs the provider that the patient is a victim of a sexual assault so that the SARC or FAP can inform the victim of services and reporting options. There is no requirement that the health care provider inform the SARC or FAP that the patient requested an abortion. Health care provider communications to a SARC or FAP are confidential. As a result, if the patient has made, or desires to make, a Restricted Report, that option is not affected by health care provider notifications to a SARC or FAP.

Yes. DOD will continue to provide necessary medical services to treat ectopic or molar pregnancies. DOD providers at MTFs will continue to provide services as part of their federal duties if medically appropriate, even if those services are restricted or prohibited by state law.

Yes, but only in cases where the life of the mother would be endangered should the fetus be carried to term, or in the case in which the pregnancy is the result of an act of rape or incest (described as “covered abortions”). There has been no change in policy or practice related to provision of abortions overseas.

The memorandum directed the to take a series of actions to ensure Service members and their families can access reproductive health care; DOD health care providers can operate effectively, consistent with federal law; and to establish uniform policies to protect the privacy of reproductive health information. Those directed policies were released on Feb. 16, 2023.

This policy standardizes and extends the timeframe for Service members to inform their commanders about a pregnancy.  Service members may now choose to delay command notification of a pregnancy until no later than the 20th week of pregnancy, except in certain circumstances. Learn More

Service members will be provided the time and flexibility to make private health care decisions in a manner consistent with the responsibility of commanders to meet operational requirements and protect the health and safety of those in their care. Service members who delay sharing their pregnancy status with their commanders will be placed on a limited duty status (as appropriate), as recommended by their treating health care provider. Additionally, there are some exceptions that may apply, based upon individual circumstances of the Service member, a potential upcoming deployment, or unit hazards. These safeguards balance Service member desire for privacy with their health and well-being, as well as unit and mission needs. Learn More

DOD providers must have a "good faith" belief that the patient is a victim of rape or incest to perform the abortion. Service members are not required to make a formal report or engage with the Sexual Assault Prevention and Response Program or Family Advocacy Program (FAP) to be eligible for an abortion, although providers are still required to notify the Sexual Assault Response Coordinator (SARC) or FAP that they are treating a patient who reports they are a victim of sexual assault, so that the SARC or FAP can inform the victim of services and reporting options. FAP clinicians are required to report suspected child abuse/child sexual abuse directly to local civilian child welfare services. There is no requirement that the health care provider inform the SARC or FAP that the patient requested an abortion. DOD providers should engage MTF legal counsel and MTF leadership, as well as subject matter experts within SAPR Program or FAP, if there are concerns about making a "good faith" belief determination. However, providers must not attempt to gain information from other sources in making their good faith determination (other than a consultation with SMEs as noted above) or compromise an adult patient's reporting options by notifying the chain of command, or law enforcement, unless otherwise indicated in DODI 6310.09 or advised by MTF legal counsel.

Commanders must protect the privacy of protected health information, and information shall be restricted to personnel with a specific need to know.

No. Any DOD personnel required to make mandatory notifications, such as those related to domestic abuse or sexual assault, in accordance with application DOD or Military Department/Service regulations, must do so. However, those required notifications must be done without disclosing the Service member’s pregnancy status.

There are military duties, occupational health hazards, and medical conditions where the proper execution of the military mission outweighs the interests served by delaying commander notification of a pregnancy. If the DOD health care provider makes the notification to a commander, the Service member will be notified prior to the command notification except in exigent circumstances. A commander will be notified of a pregnancy prior to the 20^th week if:

• The Service member is in a position pre-identified by Military Department/Service regulations as having mission responsibilities or being subject to occupational health hazards that would significantly risk mission accomplishment.
• The treating DOD health care provider has determined that there are special medical circumstances that require earlier notification.
• There are other special circumstances, determined on a case-by-case basis by a DOD health care provider, where the military mission outweighs the interests served by delaying notification.

Health care providers may only disclose information to commanders in specific circumstances, such as when the Service member’s duties will adversely impact the health and well-being of the Service member and the pregnancy. Health care providers will be required to discuss risks with Service members and recommend a limited duty status for all Service members opting to delay their notification, unless an exception applies. If the DOD health care provider makes the notification to a commander, the Service member will be notified prior to the command notification except in exigent circumstances. To address whether the Service member’s preference to delay notification is possible, health care providers will discuss risks with Service members who may be adversely impacted if they delay notification.

For the purposes of these policies, ART includes:

• Ovarian stimulation and egg retrieval, including any needed medications and procedures required for retrieval, processing and utilization for ART or cryopreservation
• Sperm collection and processing for ART or cryopreservation
• Intrauterine insemination (IUI)
• In vitro fertilization (IVF) inclusive of the following procedures for beneficiaries when clinically indicated:
  • In vitro fertilization with fresh embryo transfer
  • Gamete intrafallopian transfer (GIFT)
  • Zygote intrafallopian transfer (ZIFT)
  • Pronuclear stage tubal transfer (PROST)
  • Tubal embryo transfer (TET)
  • Frozen embryo transfer

Service members may be granted an administrative absence from their normal duty station, without being charged leave, for a period of up to 21 days to receive, or to accompany a dual-military spouse or dependent who receives, non-covered reproductive health care.

Non-covered reproductive health care is defined in policy as lawfully available assisted reproductive technology, which includes egg retrieval, IUI, and IVF, and non-covered abortion. Non-covered reproductive health care is at the patient’s expense.

More information on this policy is available at: www.health.mil/EnsuringAccesstoReproductiveHealth.

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The Department of Defense defines a covered abortion is an abortion, either medical or surgical, where the life of the mother would be endangered if the fetus were carried to term or in a case in which the pregnancy is the result of an act of rape or incest.

A non-covered abortion is an abortion, either medical or surgical, that does not meet the criteria of a covered abortion.

Active duty Service members, including Reserve or National Guard members when on active duty orders for 30 or more consecutive days, may request an administrative absence to access non-covered reproductive health care, or accompany a dependent to access non-covered reproductive health care.

An administrative absence can be requested when a Service member needs to access, or accompany a dependent to access, non-covered reproductive health care so that they do not need to use chargeable leave. Service members who are already accessing ART through the Supplemental Health Care Program are not eligible as they are able to receive such care without using chargeable leave.

It is the responsibility of Commanders or approval authorities to meet operational requirements and protect the health and safety of those in their care. Commanders or approval authorities are expected to display objectivity, compassion, and discretion when addressing all health care matters, including reproductive health care matters, and have a duty to enforce existing policies against discrimination and retaliation in the context of reproductive health care choices.

Commanders or approval authorities must act promptly when considering a Service member’s request for an administrative absence to access non-covered reproductive health care, with due regard to the time-sensitive nature of many non-covered reproductive health care services. Requests for administrative absence should be given all due consideration and should be granted to the greatest extent practicable unless, in the commanding officer’s judgment, the Service member’s absence would impair proper execution of the military mission.

Commanders or approval authorities will not levy additional requirements on the eligible Service member (including, but not limited to, consultations with a chaplain, medical testing, or other forms of counseling) prior to approving or denying the administrative absence request.

Commanders must protect the privacy of protected health information, and information shall be restricted to personnel with a specific need to know.

Yes. Service members on Active Duty may choose to request regular leave or special liberty instead of an administrative absence to access non-covered reproductive health care. Special liberty would be limited to no more than 4 days.

Service members are already authorized to receive covered abortions and do not need to be in a leave or liberty status in order to access this care.

Service members who are eligible for a covered abortion may seek care at their local military medical treatment facility. Existing processes exist to fund travel for Service members who must receive covered care outside the local area.

No. Service members will not be granted an administrative absence to access non-covered reproductive health care if the intent is to sell, offer for sale, or receive proceeds from a sale resulting from an ART procedure.

Service members whose requests for an administrative absence to access non-covered reproductive health care are denied may appeal their request in accordance with applicable Military Service policy.

The Department of Defense defines a covered abortion is an abortion, either medical or surgical, where the life of the mother would be endangered if the fetus were carried to term or in a case in which the pregnancy is the result of an act of rape or incest.

A non-covered abortion is an abortion, either medical or surgical, that does not meet the criteria of a covered abortion.

For the purposes of these policies, ART includes:

• Ovarian stimulation and egg retrieval, including any needed medications and procedures required for retrieval, processing and utilization for ART or cryopreservation
• Sperm collection and processing for ART or cryopreservation
• Intrauterine insemination (IUI)
• In vitro fertilization (IVF) inclusive of the following procedures for beneficiaries when clinically indicated:
  • In vitro fertilization with fresh embryo transfer
  • Gamete intrafallopian transfer (GIFT)
  • Zygote intrafallopian transfer (ZIFT)
  • Pronuclear stage tubal transfer (PROST)
  • Tubal embryo transfer (TET)
  • Frozen embryo transfer

Service members and eligible dependents may be authorized travel and transportation allowances to access non-covered reproductive health care services when timely access to non-covered reproductive health care services is not available within the local area of the member’s permanent duty station, temporary duty location, or the last location the dependent was transported on authorized government orders.

Non-covered reproductive health care is defined in policy as lawfully available assisted reproductive technology and non-covered abortion. Non-covered reproductive health care is at the patient’s expense.

More information on this policy is available at: www.health.mil/EnsuringAccesstoReproductiveHealth.

For non-covered ART, travel and transportation allowances for Service members (including Active Duty Service members and Reserve Component Service members on active duty orders for 180 days or more) and spouses of such Service members receiving care may be authorized when the non-covered ART procedure is substantiated in documentation by the licensed health care provider or clinic that will be performing the ART services. Funded travel can be requested by Service members for their own, or their spouse’s, care and may include a non-medical attendant to accompany either the Service member or spouse, when necessary. Substantiating documentation provided by the traveler to the approving official (AO) must include details of the procedures to be performed, dates of consultation appointments and/or procedures, and include any of the following: identification of a treatment plan schedule, medical diagnosis, and patient names to verify eligibility. The non-covered reproductive health care is at the patient’s expense.

For non-covered abortion, travel and transportation allowances for Service members (Active Duty Service members, Reserve Component Service members on active duty orders for more than 30 consecutive days, and Service academy cadets and midshipmen) and dependents of such Service members receiving care may be authorized when a licensed medical provider has validated the pregnancy and substantiating documentation is provided. Funded travel can be requested by Service members for their own, or their dependent’s, care and may include a non-medical attendant to accompany either the Service member or dependent, when necessary. The non-covered reproductive health care is at the patient’s expense.

Service members may be authorized standard travel and transportation allowances as detailed in the Joint Travel Regulations par. 033001.

Eligible dependents and escorts may be authorized the actual cost of lodging, the actual cost of meals, and round-trip transportation between the Service member’s permanent duty station or last location the dependent was transported on authorized government orders and the non-covered reproductive health care service care location. The non-covered reproductive health care is at the patient’s expense.

Service members who are eligible for a covered abortion may seek care at their local military medical treatment facility and do not need to request travel and transportation allowances under this policy. Existing processes are in place to fund travel for Service members who must receive covered care outside the local area.

It is the responsibility of Commanders or approval authorities to meet operational requirements and protect the health and safety of those in their care. Commanders or approval authorities are expected to display objectivity, compassion, and discretion when addressing all health care matters, including reproductive health care matters, and have a duty to enforce existing policies against discrimination and retaliation in the context of reproductive health care choices.

Commanders must protect the privacy of protected health information, and information shall be restricted to personnel with a specific need to know.

Active duty Service members and their dependents are eligible to request and receive funded travel when non-covered reproductive health care services are not available locally.

Yes. For the Dependent Invitational Travel Order, certain conditions apply. Travel authorizations/vouchers are processed for the family member of a Service member. The sponsor can receive reimbursement for the dependent's transportation and approved travel expenses. Either the sponsor or a Defense Travel Administrator will assist with document processing as the dependent may have no access to DoD travel systems like the Defense Travel System or MyTravel.

Service members whose requests for travel and transportation allowances for non-covered reproductive health care may appeal their request in accordance with applicable Military Service policy.

Military and civilian health care providers working in military medical treatment facilities may request reimbursement to receive an alternate license when their current license is in a state where the provision of federally authorized health care is restricted.

Yes. DOD providers may continue to provide covered abortion services as part of their federal duties if medically appropriate, even if those services are prohibited by state law or licensing requirements. (A “covered abortion” is one DOD is authorized to perform under federal law, in cases where the life of the mother would be endangered if the fetus were carried to term, or where the pregnancy is the result of rape or incest.) 

Consistent with DOD Instruction 6025.27, “Medical Ethics in the Military Health System,” Nov. 8, 2017, providers who, as a matter of conscience or moral principle, do not wish to perform abortions are generally not required to do so.

Yes. Eligible DOD beneficiaries are encouraged to follow-up with their primary care manager or Women’s Health Provider following a pregnancy termination to obtain necessary follow-up care, to include convalescent leave (as indicated) or provision of contraception. This follow-up care is available regardless of whether the abortion service was a covered or non-covered procedure. Additionally, if a patient comes to a MTF with acute complications following a pregnancy termination, it is the duty of the receiving provider to care for these acute issues. By regulation, Active Duty Service members who experience complications resulting from a non- covered treatment also may be authorized for treatment in the private sector if necessary, consistent with applicable law.

DOD providers must have a “good faith” belief that the patient is a victim of rape or incest to perform the abortion. Service members are not required to make a formal report or engage with the Sexual Assault Prevention and Response Program or Family Advocacy Program (FAP) to be eligible for an abortion, although providers are still required to notify the Sexual Assault Response Coordinator (SARC) or FAP that they are treating a patient who reports they are a victim of sexual assault, so that the SARC or FAP can inform the victim of services and reporting options. There is no requirement that the health care provider inform the SARC or FAP that the patient requested an abortion. DOD providers should engage MTF legal counsel and MTF leadership, as well as subject matter experts within SAPR Program or FAP, if there are concerns about making a “good faith” belief determination.

However, providers must not attempt to gain information from other sources in making their good faith determination (other than a consultation with SMEs as noted above) or compromise an adult patient’s reporting options by notifying the chain of command, or law enforcement, unless otherwise indicated in DOD Instruction 6310.09 “Health Care Management for Patients Associated With a Sexual Assault,” May 7, 2019, or advised by MTF legal counsel.

Easy, convenient, and timely access to the full range of contraceptive methods and counseling is a goal of the Military Health System. To better facilitate access at military medical treatment facilities, the MHS has implemented walk-in contraceptive services at every MTF with appropriate clinical capabilities. These clinics do not require appointments and are staffed with health care personnel who are trained in the full range of contraceptive methods, including short-acting reversible contraceptives (e.g., birth control pill, patch, or ring) and Long Acting Reversible Contraceptives, such as intrauterine devices and implants.

To find the closest facility to you, please visit https://tricare.mil/WalkinContraceptiveServices.

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Cost-sharing amounts for prescription pharmaceuticals obtained outside a MTF, including oral contraceptive pills, are set in law, and would require a statutory change to waive. However, prescription pharmaceuticals are available to all eligible TRICARE beneficiaries in a MTF at no cost.

Co-pays have been removed for medical procedures associated with contraceptive care, such as placement of intrauterine devices, implants and female tubal sterilizationA surgical procedure that cuts the fallopian tubes out or ties them to permanently prevent pregnancy. tubal sterilization. 

DOD will continue providing IUDs and other contraceptive care in MTFs, consistent with federal law, regardless of state law restrictions.

Primary care providers who have been trained in placement (e.g., Family Medicine Physicians, Adolescent Medicine Physicians, Family Nurse Practitioners) and Women’s health providers (e.g., OB/GYN physicians, Women’s Health NPs, Certified Nurse Midwives) may place LARCs, as may other primary care providers who have been trained in placement (Family Medicine Physicians, Adolescent Medicine Physicians, Family NPs, etc.). In general, LARCs are provided during either an outpatient primary care, Certified Nurse Midwife, OB/GYN appointment, or less commonly, in a freestanding ambulatory surgery center or outpatient hospital department (e.g., when anesthesia is required). Beneficiaries outside an MTF may contact their Managed Care Support Contractor for assistance to locate a provider and navigating their plan.

Oral emergency contraceptives, such as Plan B and ella, are covered within DOD and by the TRICARE Pharmacy benefit. Plan B is available at MTF or network retail pharmacies without need for prescription and with no copay. Ella is available via prescription at MTF or network retail pharmacies (copay for non-Active Duty beneficiaries at retail only). For network retail pharmacies, the beneficiary (or a friend or partner picking up for the beneficiary) must provide documentation of patient identity and TRICARE eligibility, generally an appropriate ID card, in order for the pharmacy to process the TRICARE Pharmacy benefit claim. Plan B is also available for purchase in many Military Exchanges, pharmacies, and other local retailers.

DOD will continue to provide Plan B, ella, and other contraceptive care in MTFs, consistent with federal law, regardless of state law restrictions. If a state prohibited emergency contraceptives, we expect that private sector retail pharmacies operating in that state would comply with state law.

Currently, emergency contraceptives like Plan B or ella are not available via home delivery, given potential delays in receipt of medications via mail order. Home delivery utilization is best served for chronic conditions and not acute conditions where timing of medications, such as emergency contraceptive, is critical.

The DOD can perform or pay for abortion services for Service members, dependents, or other eligible DOD beneficiaries in certain circumstances. Consistent with federal law, this care is provided in cases where the life of the mother would be endangered should the fetus be carried to term, or in the case in which the pregnancy is the result of an act of rape or incest (described within DOD as “covered abortions”). Federal law prohibits the DOD from performing, or paying for the performance of, abortions for any other reason.

The Military Health System (MHS) has the capability to perform both medical abortions (which are performed with medication) and surgical abortions, in cases where the life of the mother would be endangered if the fetus were carried to term or in the case in which the pregnancy is the result of an act of rape or incest.

Yes, TRICARE will continue to pay for abortions for Service members, dependents, or other eligible DOD beneficiaries in cases where the life of the mother would be endangered should the fetus be carried to term or in the case in which the pregnancy is the result of an act of rape or incest (described as “covered abortions”). Private sector health care facilities are subject to the laws of the state where the care is provided. When state law restricts certain types of care, that care may no longer be available through private sector health care facilities in the local area.

However, military medical treatment facilities are still authorized to provide covered abortions, even when state laws restrict such care. When not available in the private sector, Service members and eligible beneficiaries may access care at a local military medical treatment facility or travel to the closest military medical treatment facility with the necessary capability. The following question outlines current processes for accessing covered care not available locally for beneficiaries. Beneficiaries seeking assistance with access to a covered abortion can contact https://health.mil/ContactUs, for assistance.

For a covered abortion, DOD provides the following travel and transportation allowances:

• Active Duty: Active Duty Service members (including Reserve Component Service members on Active Duty orders for a period greater than 30 days) who require authorized medically necessary care that is not available in their local area, including covered abortions, will be authorized to travel at government expense to receive the care. The Service member would need to provide their command with documentation from their medical provider indicating the need to travel for a necessary medical procedure. A description of the medical procedure would be contained in the individual’s medical records. The Service member would not be required to take leave for the travel.
• Other Beneficiaries:
  • TRICARE Prime: For non-Active Duty patients enrolled in TRICARE Prime, if the closest available care is more than 100 miles away from their primary care manager’s office, TRICARE may reimburse reasonable travel expenses for covered abortions in accordance with applicable rules and regulations.
  • TRICARE Select: For non-Active Duty patients enrolled in TRICARE Select, a referral will be made but there is no associated reimbursement for travel costs.
• Dependent Outside the Continental United States (OCONUS): Dependents accompanying Active Duty Service members (including Reserve Component members on Active Duty orders for a period greater than 30 days) stationed outside the Continental United States may be paid travel and transportation allowances to the nearest medical facility where a covered abortion could be performed. A written statement from a DOD medical authority must support the need for travel confirming both the seriousness of the condition and the absence of adequate military and civilian facilities for proper treatment.

DOD performs or pays for abortions for Service members, dependents, or other eligible DOD beneficiaries in cases where the life of the mother would be endangered should the fetus be carried to term or where the pregnancy is the result of an act of rape or incest (described as “covered abortions”). An eligible beneficiary can request a covered abortion from a MTF provider.

Patients may seek assistance from a Sexual Assault Response Coordinator (SARC), Sexual Assault Prevention and Response Victim Advocate (SAPR VA) or the Family Advocacy Program (FAP) who can connect them with the appropriate health care provider. They may also seek assistance through their primary care manager (PCM), a women’s health provider, or at an emergency room. MTFs either have providers who perform abortion services or have the ability to refer patients to an appropriate provider in the private sector or at another MTF.

Complete care generally includes an initial diagnosis of pregnancy, counseling regarding pregnancy options, any necessary pre-procedural evaluation, peri-operative care (care provided around the time of a surgical procedure), contraception counseling and provision, screening for sexually transmitted infections, referral for mental health services, and follow-up/post-operative care as required. Sexual Assault Response Coordinators (SARCs) or the Family Advocacy Program (FAP) are notified by a DOD medical provider at an MTF if a patient informs the provider that the patient is a victim of a sexual assault so that the SARC or FAP can inform the victim of services and reporting options. There is no requirement that the health care provider inform the SARC or FAP that the patient requested an abortion. Health care provider communications to a SARC or FAP are confidential. As a result, if the patient has made, or desires to make, a Restricted Report, that option is not affected by health care provider notifications to a SARC or FAP.

Yes. DOD will continue to provide necessary medical services to treat ectopic or molar pregnancies. DOD providers at MTFs will continue to provide services as part of their federal duties if medically appropriate, even if those services are restricted or prohibited by state law.

Yes, but only in cases where the life of the mother would be endangered should the fetus be carried to term, or in the case in which the pregnancy is the result of an act of rape or incest (described as “covered abortions”). There has been no change in policy or practice related to provision of abortions overseas.