How To Apply For Insurance For A Newborn

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.

What To Look For When Choosing A Policy

The important words to remember when shopping for a policy are “premium” and “deductible.” The premium is the amount you pay each month for coverage. The deductible is the amount you need to pay each year for medical services before your health insurance kicks in. As a general rule, insurance plans with low premiums have high deductibles, and plans with high premiums have low deductibles.

These are the basic levels of coverage:

• Catastrophic insurance is designed to protect an otherwise healthy person in the event of a major injury or illness. It’s available only to people under age 30 and those who are exempt from other plans due to hardship. This type of insurance can have low premiums but very high deductibles. Plans generally cover less than 60% of the costs of health care.
• Bronze plans also have low premiums and high deductibles, but they offer better coverage than catastrophic insurance, typically paying for 60% of costs.
• Silver plans and gold plans have average-sized premiums and average-sized deductibles. Silver plans cover 70% of costs. Gold plans pay 80% of costs.
• Platinum plans, the highest level of coverage, have high premiums and low deductibles. These plans cover 90% or more of health care costs.

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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Dont Get Stuck Without Newborn Insurance Coverage In California

Neglecting to plan to get health insurance for your newborn will result in significant financial burdens. If a mother has a child without insurance in California, she could owe up to $45,000 for the delivery of her child alone. Even if both parents have insurance, failing to get a plan in place for their newborn to have coverage on day 31, after the 30 days of coverage as an extension of the mother, can result in paying an additional 20% more the entire first year as a penalty for not having coverage.

At Health for California, our goal is to make it easy for Californians to get the health insurance coverage they need for themselves and their newborn. Our website is focused on educating those who may not know much about health insurance, and to make it easy to find an affordable health insurance solution for mothers, fathers and children. Begin your new adventure as parents by requesting a free, no obligation quote on our website so you can be sure your newborn has the best health insurance plan from the moment they arrive.

Not sure how Obamacare affects your health care plans in California? Learn how the ACA works in California, including benefits, costs and enrollment.

How To Apply For Social Security Benefits

If you think your baby may qualify for SSI benefits, you should apply as soon as you are able. Although it can take up to three to five months for the Social Security Administration to decide eligibility for most children with disabilities, it will grant SSI immediately to families of babies who weigh less than 2 lbs 10 oz at birth. However, other preemies with low birth weight or babies with growth failure after birth won’t receive SSI payments until the application and review processes are complete.

Your infants birth weight must be documented by an original or certified copy of the birth certificate or in a medical record signed by a physician. If your child fails to grow as expected and has developmental delays, it’s important to collect and submit regular doctor’s records with your application.

To apply for SSI benefits, you can visit your local social security office or call the Social Security Administration at 1-800-772-1213. Also, don’t hesitate to check if the hospital where you delivered your baby can help many neonatal intensive care units have representatives who are pros at guiding parents through the SSI application process.

If you have applied for and received immediate SSI relief for your baby with low birth weight and it’s determined that your baby doesn’t meet all the requirements for disability benefits, after all, you won’t have to pay back any payments you received to that point.

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I Am Pregnant How Does The Newborns Act Affect My Health Care Benefits

The Newborns Act affects the amount of time you and your newborn child are covered for a hospital stay following childbirth. Group health plans, insurance companies, and HMOs that provide maternity benefits may not restrict benefits for a hospital stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section. However, the attending provider may decide, after consulting with you, to discharge you or your newborn child earlier. In any case, the attending provider cannot receive incentives or disincentives to discharge you or your child earlier than 48 hours . The Newborns Act does not require plans, insurance companies, or HMOs to provide coverage for hospital stays in connection with childbirth. Other legal requirements, including Title VII of the Civil Rights Act of 1964, may require this type of coverage.

How Does Giving Birth To Or Adopting A Baby Affect My Rights To Enroll In My Health Plan Or Health Insurance Coverage

Under HIPAA, you, your spouse, and your new child have a special right to enroll in your health plan upon the birth, adoption, or placement for adoption of your new child, if you, your spouse, and your new child are otherwise eligible to enroll in the plan. You must request enrollment in the plan within 30 days of the birth, adoption, or placement for adoption. Your plan or insurance issuer may not treat you or your spouse as a late enrollee in this circumstance. So, for example, the longest preexisting condition exclusion that could be imposed on you or your spouse is 12 months. Your familys coverage under this type of special enrollment must be effective as of the date of the birth, adoption, or placement for adoption.

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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?

Individual Or Employer Insurance Plan Doesnt Cover A New Baby

If you have your health insurance policy, your baby is born into coverage, right? Sort of. For the first 30 days of your newborns life, he or she will be covered as an extension of the mother, under her policy and her deductible. Starting on day 31 of the newborns life, your baby will need to have his or her policy. That policy could simply mean adding your newborn to your employer insurance plan, or turning your individual plan into a family plan but dont forget that takes time, paperwork and money. If you dont have a plan in place to get coverage immediately after your little one is born, youll miss out on having some of those first few well-baby checkups completely covered. If your baby goes even one day without coverage between being on the mothers insurance and being added to his or her own insurance plan, you could be subject to an additional 20% cost penalty during the first year of your babys health insurance coverage which is already the most expensive year for health insurance.

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You Can Update Your Number Of Dependents Starting In September

While the IRS has been rolling out more features to the portal , like updating your bank information and unenrolling from monthly payments, you wont be able to change the number of dependents in your care until late summer .

For parents whove already had a child in 2021, this unfortunately means that you wont be receiving monthly payments for July, August or September. Parents also wont receive any monthly payments until the child is actually born, so even if youre due in October, you wont be able to include them as a dependent right when the portal opens in September.

Once its possible to update your number of dependents or your child is born , you will finally be able to claim them for the child tax credit.

Covered California Quotes For Individuals And Families

The Covered California Health Exchange is a government agency that helps Californians comply with Obamacare. To comply with Obamacare, you need to have insurance coverage from a qualified health plan that meets the governments requirements. While you usually can only enroll during the open enrollment period, the birth of a child gives you the ability to apply for Covered California health insurance outside of the open enrollment period.

Parents who are expecting a newborn may want to consider shopping for a new insurance plan for the following reasons:

• The cost of adding your newborn to your pre-existing plan is high.
• You and your partner do not currently have insurance.
• You and your partner would like to get on an insurance plan together when the child is born.

Fill out a simple online form with some basic information, including your income, and youll see a variety of plans in your search results. The details you will be able to compare include:

• Carrier Name
• Plan Category
• Plan Type
• Full Price of Plan
• Subsidy Amount You Qualify For
• Link to View Benefits

Your income level may qualify you for discounted rates all of which you can find on the Health for America website. There are additional parameters for pregnant women with low incomes, too. As a female who is expecting, you could qualify for Medi-Cal. Entering your household income information in the optional section of the forms will ensure all of the plans you are eligible for will appear in the results.

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Ssi Eligibility For Preemies

Simply being born prematurely doesn’t qualify your child for social security benefits. To be eligible for SSI, a baby must have one of the following conditions:

• Low weight at birth: Any baby who weighs less than 2 pounds, 10 ounces at birth qualifies for SSI.
• Low birth weight for their gestational age: Babies who are very small for their gestational agewhat age they are from conception, not birthcan qualify for SSI. For example, a full-term baby, born between 37 and 40 weeks, still qualifies for SSI if they weigh less than 4 pounds, 6 ounces at birth.

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 Can You Make Sure Your Newborn Is Covered

Remember that your infant should automatically receive coverage for at least the first 30 days of life. Youll want to ensure your baby gets covered after thatthe cost of essential immunizations, screenings, and other necessary medical exams can mount up.

The earlier you start inquiring about newborn health insurance to continue coverage after day 30, the better. Check in with your insurance provider about the terms of their special enrollment period for qualifying life events.

If youre currently not covered by any plan, several government programs can cover essential health services for your infant.

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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