Donated Human Breast Milk. We cover pasteurized donated human breast milk for [Members] under the age of six months subject to the following conditions:
Donated Human Breast Milk. We cover pasteurized donated human breast milk for [Members] under the age of six months subject to the following conditions: The [Member] is medically or physically unable to receive maternal breast milk or participate in breast feeding, or the [Member’s] mother is medically or physically unable to produce breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support; and The [Member’s] Practitioner issued an order for the donated human breast milk We also cover pasteurized donated human breast milk as ordered by the [Member’s] Practitioner for [Members] under the age of six months if the [Member] meets any of the following conditions: A body weight below health levels determined by the [Member’s] Practitioner; A congenital or acquired condition that places the [Member] at a high risk for development of necrotizing enterocolitis; or A congenital or acquired condition that may benefit from the use of donor breast milk as determined by the New Jersey Department of Health. As used in this provision, pasteurized donated human breast milk means milk obtained from a human milk bank that meets the quality guidelines established by the New Jersey Department of Health. If there is no supply of human breast milk that meets such guidelines there will be no coverage under this provision. The pasteurized donated human breast milk may include human milk fortifiers if indicated by the [Member’s] Practitioner.
