Doula Benefits: Sample Policies
Why Doula Access Matters:
Doulas are trained support professionals who provide care to pregnant and postpartum women* outside of their regular prenatal medical care. This support helps women handle the physical, emotional and practical issues surrounding pregnancy and childbirth.
Studies have found access to pre- and post-natal doula services leads to better health outcomes, particularly for black, brown and indigenous women in the U.S. The positive impacts of doula care includes fewer cesarean births, fewer preterm births, and a reduction in post-birth complications. Doulas can be trained through different programs, some formal and others more informally, but there are a number of doula-certifying organizations — including DONA International, PALS Doula and the National Black Doulas Association — that are recognized as third-party accrediting organizations by the 21 state Medicaid programs that cover doula services.
In addition to improving the overall health and well-being of pregnant and post-partum women, having access to a doula benefit can lower the overall health expenses associated with pregnancy and child-birth. By providing prenatal doula benefits to their pregnant employees, employers can on-average save $1,193.94 / employee in avoided cesarean sections costs alone. Employees with access to doula care are also more likely to: avoid pre-term labor and have a shorter labor; initiate breastfeeding earlier and breastfeed for longer; have positive feelings about their birth experience; and experience better parent-baby bonding.
What services can a Doula provide?
DONA International, “the world’s first, largest and leading doula certifying organization,” describes the services doulas can provide as follows:
Doulas check-in with pregnant women more frequently than doctors do, and are often the first to identify potential medical complications such as pre-eclampsia. Having pre-natal doula support ensures that women receive the care needed to identify early and avoid potential pregnancy complications. In addition, doulas offer
Emotional Support:
“The transition into new parenthood can be vulnerable, and postpartum doulas are experts in emotional support, active listening and encouraging their clients to follow their own hearts.“
Evidence-Based Information and Support:
“Doulas are trained to understand what new babies – and new parents – truly need. The doula helps with soothing techniques, offers lactation or bottle feeding support, and explains normal newborn behavior and postpartum recovery expectations.“
Practical Support:
“It’s all hands on deck with a new baby, and postpartum doulas can help the days go by more smoothly by helping with the baby’s laundry, doing the dishes or preparing simple, nourishing meals.“
Partner and Sibling Support:
“A new baby means transition for everyone, including parents, grandparents and little brothers and sisters. Postpartum doulas understand what everyone needs, and part of their role is to help the entire family adjust and settle in.“
Source linked here.
How are Doula Services Covered?
Unfortunately, doula services are considered non-medical expenses by most insurance plans. However, these services can be reimbursed through HSAs or FSAs, though they often require a letter of medical necessity to be provided by a primary-care provider. Doula services are also an option made available through supplemental pregnancy and fertility platforms — such as Carrot, Maven, Progyny and others - that are increasingly focusing on whole women’s health.
What is an HSA?
An HSA — or Health Savings Account — is an alternative cost reimbursement mechanism that allows employees to set aside money from their paycheck on a pre-tax basis to pay for qualified medical expenses.
HSAs belong to the employee and can be taken from job to job, although they must be enrolled in a High Deductible Health Plan (HDHP), not enrolled in Medicare, and not claimed as a dependent on anyone else’s tax return in order to qualify.
Both employers and employees can contribute to a HSA, and funds not used roll over to the next year.
What is an FSA?
An FSA — or Flexible Spending Account — is another alternative cost reimbursement mechanism which also allows employees to set aside money from their paycheck on a pre-tax basis to pay for qualified medical expenses.
FSAs belong to the employer: if an employee leaves a job, the employer retains the funds in their FSA. Employees do not have to be enrolled in an HDHP to be eligible for an FSA.
FSAs can be used to cover dependent care costs in addition to healthcare expenses.
Doula benefits can be reimbursed via an employee’s HSA or Healthcare FSA. [1]
Other ways to provide doula services
Some private insurance providers — including Premera, which covers doula benefits under Microsoft’s Health Care Connect Plan — offer doula coverage through “maternity care bundles” that employees can opt into. Unlike fee-for-service reimbursement, which compensates providers for each service, bundled payment combines all the services provided during a defined episode of care into a single, fixed rate. [2]
In addition, third-party women’s health and fertility platforms - such as Carrot, Maven, and Progyny - provide doula services. While these services are offered through these platforms, the employer typically must opt-in to include doula into their workplace benefits offering.
Sources linked [1] here and [2] here.
Sample Policies:
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"Doula Q&A
What is a doula?
A doula is a person experienced in childbirth who provides advice, information, emotional support, and physical comfort to a mother before, during, and just after childbirth.
Who is eligible for the doula allowance?
Members in the Health Connect Plan are eligible.
How do I access the $1,000 doula allowance?
You will need to pay for doula expenses out of pocket, then complete and submit the Doula Claim Reimbursement Request form for reimbursement.
Does the doula replace nursing staff?
No, doulas do not replace nursing staff. This is an additional benefit available to members in the Health Connect Plan.
What effects does the presence of doulas have on birth outcomes?
Researchers have found that expectant mothers paired with a doula have better outcomes for mothers and babies. Mothers are less likely to have a C-section, and babies are less likely to be born prematurely or be of low birthweight.
Is a doula the same as a midwife?
A doula is not the same as a midwife. A midwife is a licensed health care professional whose focus is on delivering a healthy baby. Doulas, on the other hand, aren’t licensed to deliver babies. A doula’s primary focus is on the needs of the mother, offering education, support, and advocacy.
Can a doula attend C-section births?
Please refer to your Health Connect Network provider as rules/policies may vary between providers.
Can I choose my own doula?
Yes. Before seeking doula services, you must be examined by a licensed physician, registered nurse, or midwife and have a confirmed pregnancy.
The doula must be state-licensed if the state requires a license. If the state does not require a license, then the doula must have a current certification under a recognized doula certification organization (examples include DONA International and PALS Doulas).
Eligible doulas do not have to be in the Health Connect Network or Extended Network. Exclusions include apprentice doulas.
What services are covered with the doula allowance?
Covered doula services include:
In person, phone, and email support throughout the pregnancy and postpartum
Birth support
Lactation support
Doula services are not covered for the following:
Babysitting or doing household chores
Travel time
Does a doula make decisions on my behalf?
No. Doulas will not make decisions or interfere in your clinical care. A doula can provide informational, physical, and emotional support, while respecting your decisions.
Are there restrictions with doulas in the delivery room?
Doulas are subject to the facility’s attendance restrictions. Please refer to your provider.
Can I use my HSA or FSA for doula expenses?
Certain doula expenses not already paid by your health plan (amounts above the $1,000 allowance) are HSA/FSA eligible with a letter of medical necessity signed by your doctor and a detailed receipt.
The following doula services are HSA/FSA eligible:
Itemized medical care only, from a certified doula
The following doula services aren’t HSA/FSA eligible:
Emotional support
Parenting information
Childcare
Housekeeping
Why is the doula allowance not offered on the Health Savings Plan?
The Health Connect Plan provides an opportunity to pilot this innovative benefit. We’ll use your feedback in future benefit planning sessions to help guide decisions on all medical plans."
Source linked here (pgs. 4-5)
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The AMP (Associates' Medical Plan) covers doula services for pregnant women enrolled in the Premier, Contribution, or Saver Plan, or local plan options, regardless of medical necessity. The benefit is limited to $1,000 per pregnancy. Coverage is not subject to the deductible, and no coinsurance or copay is required. Amounts paid for doula services do not apply to the deductible or out‑of‑pocket maximum.
The doula must be certified through the National Black Doula Association or DONA International, or part of the Kindbody Virtual Doula Program offering. Amounts for doula services are taxable to you. The administrator of the doula benefit is UMR.
Prior to November 1, 2023, this benefit was available only in Georgia, Illinois, Indiana, and Louisiana. Effective November 1, 2023, the AMP covers doula services for pregnant women enrolled in the Premier, Contribution, or Saver Plan, or local plan options nationwide, except Hawaii.
What does the RMH Compass Standard say about Doula Benefits?
The RMH Compass Standard incorporates doula benefits in Doula, Lactation and Midwifery Benefits. The specific measurement of doula benefits includes:
“ […] Doula services and lactation services covered/reimbursed via ESHP or third-party vendor (Carrot, Maven, Progyny, other).”
Both Microsoft’s and Walmart’s policies meet this standard for doula benefits, as both cover doula services.
“Doula services covered up to $1500 or more through a maternity bundle or similar benefit offered through an employer-sponsored health plan or third-party vendor (such as Progyny, Carrot, Maven, etc) available to all eligible workers and their dependents.”
Neither Microsoft nor Walmart meet RMH Compass’ “Best” standard, as neither explicitly reimburses up to $1500 in doula services.
*We use the word “women” expansively to be inclusive of transgender and gender nonconforming people, intersex people, as well as other gender identities who share reproductive experiences such as menstruation and menopause.
