Important Information For New Or Soon
If you have health coverage and are pregnant, you and your new child may be entitled to a 48-hour hospital stay following childbirth . If your employer or your spouses employer offers a health plan, birth, adoption, and placement for adoption may also trigger a special enrollment opportunity for you, your spouse, and your child, without regard to any open season for enrollment.
The Affordable Care Act adds important protections related to employment based group health plans that will improve health coverage for you and your family. Many of these protections are available now including extending dependent coverage until age 26, prohibiting preexisting condition exclusions for children under 19, and banning lifetime limits on coverage for essential health benefits. Additional protections will be available in 2014. This publication does not reflect the provisions of the Affordable Care Act. For more information, visit the Employee Benefits Security Administrations ACA Web page at dol.gov/ebsa/healthreform.
How Long Will Your Kid Be Covered By Your Policy
In most cases, Australian private health funds allow you to cover your children for free under the same membership until they reach the age of 18. However, this can be extended to include cover for an older child in the following circumstances:
- As a child dependant. Your child will need to be under the age of 21, unmarried and financially dependent on you.
- As a student dependant. Your child will need to be under the age of 25, unmarried and studying full-time.
In addition, some funds allow cover for non-student adult dependants up to 25 years of age, but an additional premium will usually apply. Once your child reaches the relevant age they will need to apply for their own health insurance cover.
If you have adopted children, foster children or stepchildren, rest assured that they will be covered in the same way as biological children.
Does My Individual Or Family Plan Automatically Cover My New Baby
After your baby is born, your child is covered for the first 30 days of life as an extension of you, the mother, under your policy and deductible.
Starting on day 31, this extension of coverages ends. While maternity care and some health care services for children are essential benefits that are covered by all marketplace plans, health insurance for babies is not included as an essential benefit. To get health insurance at this time, you must enroll in or change your health insurance plan.
Having a child is a qualifying life event that triggers a special enrollment period. During the special enrollment period, you can enroll in a plan or change your current plan without waiting for the open enrollment period to begin. The special enrollment period extends for 60 days after your childs birth. Once enrolled, the effective date is retroactive to your childs birthdate.
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The Mother And/or Father Has Health Insurance Through An Employer
If you have a group health insurance policy through your employer, start by talking to your human resources office. Here are a few questions you should ask:
- How much will it cost to add my newborn to my group plan?
- What are the benefits that are included in that price? Are there any specific to newborns?
- What paperwork do I need to fill out to add my newborn to my group plan?
- What is the deadline to have the paperwork submitted?
- When will the coverage start?
The mother and father of the baby should compare notes on how much it will cost to add the child to the group plan and should also review the benefits of each plan to determine the best value. If one parent has health insurance through an employer, and the other parent has an individual health insurance plan, review the cost and the benefits to see which policy is best for your newborn.
May My Plan Or Health Insurance Coverage Impose Preexisting Condition Exclusions On My Newborn Child Adopted Child Or Child Placed For Adoption
Under HIPAA, as long as you enroll your newborn child, adopted child, or child placed for adoption within 30 days of the birth, adoption, or placement for adoption, your plan or insurance coverage may not impose preexisting condition exclusions on the child. Further, any future plan may not impose a preexisting condition exclusion, provided the child does not incur a significant break in coverage .
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How Parents Can Switch Health Plans After The Birth Of A Newborn
In addition to making changes to their existing benefits plan, a qualifying event also permits parents to switch health plans entirely during the SEP. For example, a married couple who just had a baby may decide to move from the health insurance plan provided by one persons employer to the plan provided by the other persons employer.
Having a child is expensive. Employees may inquire about costs during this process, especially if theyre choosing between their current health plan and an alternative.
As HR, it can be helpful to ask employees the following questions to help them make their decision:
May Group Health Plans Insurance Companies Or Hmos Impose Deductibles Or Other Cost
Yes, but only if the deductible, coinsurance, or other cost sharing for the later part of a 48-hour stay is not greater than that imposed for the earlier part of the stay. For example, with respect to a 48-hour stay, a group health plan is permitted to cover only 80 percent of the cost of the hospital stay. However, a plan covering 80 percent of the cost of the first 24 hours could not reduce coverage to 50 percent for the second 24 hours.
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How Long Do I Have To Add My Newborn To My Insurance
Group health insurance plans require you to add a baby within 30 days or 60 days after a baby is born. Having a child is considered a qualifying life event that starts a special enrollment period. The periods length varies by employer.
During that special enrollment period, you can make changes to your health insurance, including adding a new baby to the health coverage. You can even enroll in a different health plan. Your health insurance company will likely request the childs birth certificate to create the special enrollment period.
If you miss the deadline for special enrollment, new parents may have to wait until the next open enrollment period to add a newborn to health insurance.
Before the child arrives, its wise to contact your employers health plan administrator to learn how and when to add your infant to the plan. Knowing those details ahead of time will make the process easier once the baby has arrived.
In addition, check the health insurance coverage for the types of health services it covers for children. Some questions to ask your health insurance company or employer:
- How much more does the health insurance plan cost when you add the child?
- Does the plan cover immunizations and well-baby visits?
- How much are copayments and what is the deductible?
Health Insurance For Babies: Documents Needed
Fortunately, it does not take a long time to get coverage for your newborn and you will only need a few documents:
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Many health insurance companies only request one but it is best to have both at hand when you call your provider or speak with your HR rep just in case.
You should have received your childs social security card in the mail after giving birth. If you have not received it yet and a reasonable amount of time has passed, contact the facility where you gave birth. Normally, parents fill the relevant forms there and then the facility submits them.
Your health insurance provider usually has access to the newborns birth records as they need information such as the place and date of birth, full name, hospital records, etc. If they do not have this information, you may need to give them a copy of your babys birth certificate.
Please note: different providers will have different processes in place to add a baby to the health insurance plan. While many companies allow you to add your child by phone, for others, you may have to fill out an enrollment form online or else. Please contact your provider in advance so that you know exactly what steps you need to take.
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Dont Forget To Add Your Baby To Your Policy
After your baby is born, add your newborn to your Horizon BCBSNJ policy so your child can continue to access the care he or she needs. In many cases, you have up to 60 days, but for some policies, the requirement is 30 days. If you miss this window, you will have to wait until your next open enrollment period to add your baby to your policy.
To enroll your newborn, you may need to provide documents, such as your baby’s birth certificate or the application for your baby’s birth certificate.
If your health plan is through your employer, contact your benefits administrator to add your baby to your policy. If you have any questions or have an individual health plan, call Member Services at the number on the back of your member ID card.
Care For Your Babys Smile Now
Dental care should begin soon after birth. Dentists recommend wiping your babys gums with a damp washcloth or soft infant toothbrush after meals. Once the first tooth erupts, start brushing gently with a soft, baby-sized toothbrush twice a day. Dentists also recommend that you schedule your childs first dental appointment by age 1.
As your baby gets bigger, teach good oral health habits. Simple preventive care, including brushing and flossing daily and regular dental visits, can help small smiles grow up healthy.
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Risk Of Not Having Newborn Insurance Coverage In California
Care for newborns tops the list as most expensive insurance claims. The key to minimizing cost and making sure your new addition is covered is planning. Theres a lot to do when youre planning for a new member of the family, especially in those first 30 days. If you havent decided what to do about getting insurance for your newborn in California before your little one arrives, it can be easy to forget insurance coverage in the midst of adjusting to life as a parent. When you do remember, theres often paperwork that needs to be completed, and coverage isnt instant leaving your new bundle of joy at risk of being without health insurance, and you with the significant financial burden that comes with post-partum out-of-pocket expenses. So what can you do to ensure your baby is protected?
What If I Dont Qualify For Special Enrollment
Depending on your income, you may qualify for Medicaid or CHIP. There is no special enrollment period for those government offered coverage options you can apply at any time.
Members of American Indian and Alaska Native tribes can enroll any month, not just during open enrollment. You can even apply for cost assistance.
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Will I Have To Pay To Add My Child To My Policy
Its possible for many Australians to take out free private health insurance for their kids. The cost of a couples private health insurance policy is the same as a family policy with most Australian health funds, so adding your children to your policy effectively doesnt cost a cent. Some funds will also waive any hospital excess that applies when your child is admitted to hospital, making it possible to enjoy even further savings on cover.
However, you may end up paying more for cover if youre a single parent who has a single membership in place. To add children to your membership, you will usually have to upgrade to a family or single-parent family membership, which will cost you more.
Parents Dont Have Health Insurance
If the mother and father of a newborn do not have health insurance, then all expenses must be paid out of pocket. A recent study found the average price tag for vaginal deliveries and c-sections in California fall between $15,000 and $45,000. Thats a huge financial burden for new parents to take on. If that isnt enough of a reason for you to get health insurance before your newborn arrives, the possibility of putting the babys health at risk should be.
Although newborn babies are covered under their mothers health insurance policy for the first 30 days, not every mother has health insurance. In this case, babies whose mothers do not have health insurance are not covered. Complications that arise during birth or shortly after will continue to add to the financial burden.
Even without complications, there are several essential doctors appointments during the first 18 months of a childs life. These office visits are considered preventative care and are covered if you have health insurance. Without it, you either skip the appointments, which can be detrimental to your childs development and health, or you pay for all of those appointments out of pocket. Not having insurance for a newborn is significantly more expensive than it is for an adult.
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Newborn Insurance Coverage In California
There is so much to prepare when youre expecting a baby especially when its the first time. In the midst of setting up the nursery, making extra trips to the doctor for prenatal appointments and securely fastening your brand new baby car seat, its surprisingly easy to forget about getting a plan in place for newborn health insurance coverage. Whether you, as a parent, have health insurance, but dont know much about it, or dont have health insurance at all, navigating the process of getting your newborn health insurance coverage can be tough.
Unfortunately, health insurance for newborns isnt something that just happens on its own. While there is a short buffer period built in to give newborns coverage through his/her mothers insurance, the longer you wait to get newborn insurance coverage in California, the more you will end up having to pay. While the Affordable Care Act and California State Laws make it mandatory for health insurance companies to accept newborns to health insurance plans, theres no guarantee on pricing. If you fail to do your part to get your newborn on a health insurance plan, you could end up spending a significant amount of money.