Electric Breast Pump

Eligibility restrictions apply. Peach State Health Plan (PSHP) members must be currently enrolled with our health plan to be eligible for Value Added Benefits (VABs). PSHP does not pay reimbursement fees on VABs. Please allow up to 30 business days for processing.

At Peach State Health Plan (PSHP), we not only care about our mothers, but we care about our babies. PSHP encourages mothers to choose breastfeeding. Breast milk helps keep your baby healthy.

Qualification Requirements. New moms who meet one of the following:

Complete Lactation and Breastfeeding Education Classes
Enrolled in a High-Risk Case Management Program
Deliver a NICU baby

One breast pump annually. 2nd Trimester or greater can order a breast pump.

I do hereby attest that this information is true, accurate and I do meet the criteria to proceed before submitting my request.

First Name *

Last Name *

Member Medicaid ID

Member Birthday

Phone Number *

Email Address *

Street Address *

City *

State *

Zip Code *

Are you pregnant? *

Yes No

Are you enrolled in Case Management? *

Yes No

What is the name of your OBGYN? *

Please enter your due date *

Are you planning to breastfeed? *

Yes No

Select one breast pump below:

Ameda Mya Joy w/Tote Bag Lansinoh Signature Pro w/Tote Bag Motif Duo w/Pumping Bra Motif Luna w/Wet-Dry Bag Motif Twist Breast Pump Medela Pump in Style w/Maxflow Zomee Z2 Breast Pump Evenflo Advanced Breast Pump

If you need assistance filling out this form, please call Member Services at 1-800-704-1484 ; TTY/TDD 1-800-255-0056