Newborns: Patients Or Policy Exclusions?

Newborn babies are considered patients by insurance and can be added to their parents' insurance plans within 30 to 60 days of birth. This is known as a Special Enrollment Period, which is triggered by certain life events such as childbirth or adoption. During this period, parents can add their newborn to their existing plan, change their current plan, or enrol in a new plan. It is important to note that the baby will be covered by their mother's policy for the first 30 days of life. After this period, separate coverage or enrolment is necessary.

Adding newborns to existing insurance plans

Having a baby is a life-changing event, and it's important to ensure that your little one has the necessary health insurance coverage. Here's a step-by-step guide to adding your newborn to your existing insurance plan:

Step 1: Contact Your Insurance Provider

Don't assume that your insurance company will automatically add your newborn to your policy. You must proactively notify them of the birth. Contact your insurance company or the health plan director at your workplace as soon as possible. If you have insurance through the Affordable Care Act (Obamacare), you can make the addition through your state's health insurance exchange.

Step 2: Understand Special Enrollment Periods

The birth of your child triggers a Special Enrollment Period, allowing you to make changes to your health insurance plan outside of the regular open enrollment period. This special enrollment period typically lasts for 60 days after your child's birth, although it may be shorter for certain plans. During this time, you can enroll your newborn in your existing plan or change your plan to better suit your new family situation.

Step 3: Gather Necessary Paperwork

You will need to provide documentation of the birth, such as a birth certificate or hospital records. In some cases, you may also need your baby's Social Security number. Contact your insurance company to find out exactly what paperwork is required. The hospital where you gave birth can assist you in completing and submitting these forms, but it usually takes a couple of weeks to obtain them.

Step 4: Compare Plan Options

If both parents have employer-based insurance, take time to research and compare each company's plans. Consider premium costs, copays, and the network of covered doctors, hospitals, and medications. You may also want to look into government programs like Medicaid and the Children's Health Insurance Program (CHIP), which offer free or low-cost coverage for newborns and pregnant women.

Step 5: Enroll Your Newborn

Once you've decided on a plan, enroll your baby as soon as possible. While the coverage is retroactive to the date of birth, processing the enrollment can take time. Contact your company's human resources department or your insurance provider directly to add your newborn to the plan.

Step 6: Check Your New Premiums

Adding a dependent to your insurance plan may result in increased premiums. Take the time to understand your new expenses and prepare for any cost changes. Family plans may allow for new dependents at no additional charge, but sometimes premiums can increase significantly.

By following these steps, you can ensure that your newborn receives the necessary health insurance coverage and that you are prepared for any associated costs. Remember, it is crucial to act promptly to avoid losing out on insurance benefits for your infant and to avoid potential penalties under the Affordable Care Act.

Special enrollment periods

The birth of a child is a qualifying life event that triggers a Special Enrollment Period (SEP) for health insurance plans. This period allows you to make changes to your health insurance plan outside of the regular open enrollment period. Here is what you need to know about Special Enrollment Periods:

Timeframe

You have a 60-day window starting from the date of your child's birth to make changes to your health insurance plan. This timeframe is crucial for making any necessary adjustments to your coverage. Your coverage can start on the day of the birth, even if you enroll up to 60 days afterward.

Plan Options

During the SEP, you can switch to a different plan that better suits your new family situation. This could mean moving to a plan with more comprehensive coverage, a larger network of pediatricians, or lower out-of-pocket costs. If you already have a health insurance policy offered via the Marketplace, you can add your newborn to your current plan or purchase a separate plan for the newborn.

Documentation Requirements

Be prepared to provide documentation such as a birth certificate or proof of birth from the hospital when you apply for a plan change. This documentation is necessary to confirm the qualifying event.

Employer-Sponsored Insurance

If your insurance is through your employer, inform your HR department about the birth of your child and discuss your options for changing plans. You will likely have at least 30 days after your child's birth to enroll your baby in your employer-based health plan.

Marketplace Plans

If you have a plan through the health insurance marketplace, you can update your application to reflect your change in family size and explore different plan options. You may also qualify for subsidies, which could lower your monthly premiums.

Impact on Premiums and Subsidies

Adding a child to your policy or changing plans can affect your premiums and eligibility for subsidies. Review these financial aspects carefully to understand how your costs may change.

Seeking Professional Advice

If you're unsure about the best course of action, consulting with a healthcare insurance professional or broker can provide clarity and help you make an informed decision.

Required paperwork

The required paperwork will differ based on the type of insurance and the insurance company. However, most insurance companies will require the following documents:

• Your baby's birth certificate or proof of birth. The hospital where you gave birth can help you complete and submit these forms, but it usually takes a couple of weeks to receive them.
• If you've adopted your baby, you'll typically need to submit the official adoption papers. If the adoption took place outside the US, this is also usually the case.
• If you have a federal or state-based marketplace health plan, you'll likely need your baby's Social Security number.

It's important to contact your insurance company to confirm the specific paperwork required and to understand the full range of benefits available for your newborn.

Timeline for Adding a Newborn to Your Health Insurance

It's worth noting that there is a timeline within which you must add your newborn to your health insurance plan. You typically have between 30 to 60 days after your child's birth to do so. Your baby will be covered by their mother's policy for the first 30 days of life. After this period, you must enrol in or change your health insurance plan. The coverage effective date will be retroactive to your child's birth date.

Cost of adding a newborn to insurance

The cost of adding a newborn to your insurance plan depends on several factors, including the type of insurance plan, your location, and the specific coverage options available to you. Here is some information on the costs and factors to consider when adding a newborn to your insurance:

Types of Insurance Plans:

There are two main types of insurance plans to consider when adding a newborn: employer-sponsored plans and individual plans.

• Employer-sponsored plans: These plans are typically offered through your workplace and often include comprehensive coverage for family members, including newborns. The cost of adding a newborn to an employer-sponsored plan can vary. Some plans may charge premiums for "family" or "self-only" coverage, and adding extra dependents may not significantly increase your premium. It's important to review the details of your specific plan.
• Individual plans: Individual plans are purchased directly by an individual, either through the health insurance marketplace or a private insurance company. Adding a newborn as a dependent to an individual plan will generally result in an additional "full" premium. The cost of this premium will depend on factors such as your age, location, and the specifics of the plan.

Location and Specific Coverage Options:

The cost of adding a newborn to your insurance can also vary depending on your geographic location and the specific coverage options you choose.

• Location: The state and city you live in can significantly impact the cost of childbirth and healthcare for your newborn. For example, the average cost of a vaginal delivery can vary by more than $30,000 between different states in the US.
• Coverage options: Different insurance plans offer varying levels of coverage for newborn care, including well-baby checkups, vaccinations, hospitalization, emergency care, specialist care, and prescription medications. Review the specific benefits and coverage limits of your insurance plan to understand what newborn care services are covered and what out-of-pocket expenses you may incur.

Special Enrollment Period:

It's important to note that the birth of a child is considered a qualifying life event that triggers a special enrollment period. This means you have a window of time, typically 30 to 60 days after the birth of your child, to add your newborn to your health insurance plan. During this special enrollment period, you may also have the option to change your current plan or explore alternative coverage options to find the most suitable and cost-effective plan for your growing family.

In summary, the cost of adding a newborn to your insurance will depend on the specific details of your insurance plan, your location, and the coverage options you select. Reviewing your plan's benefits, comparing alternative plans, and taking advantage of the special enrollment period can help you make an informed decision about your newborn's healthcare coverage.

Alternative insurance options

There are several alternative insurance options for newborns, and these can be categorised into government-sponsored programs and private insurance companies.

Government-sponsored programs

• Medicaid: This is a state and federally funded program that offers comprehensive healthcare coverage, including prenatal, delivery, and postnatal care. Eligibility for Medicaid often extends to a broader range of income levels for pregnant women, and there is no restricted enrollment period.
• Children's Health Insurance Program (CHIP): CHIP is a federal program that provides free or low-cost health coverage to children in families with limited income or special circumstances. Coverage varies by state, but typically includes dental and vision care, inpatient and outpatient care, and laboratory and X-ray services.

Private insurance companies

• Standalone child-only health plans: These plans are designed specifically to cover children's healthcare needs and are offered by multiple private insurance companies. They function similarly to standard health insurance plans, with deductibles, copayments, and coinsurance, but only extend coverage to children.
• Major Medical Health Insurance (Affordable Care Act/Obamacare): This is typically the most comprehensive coverage option, but it can also be expensive and is not always available year-round. To make these plans more affordable, you may qualify for a QHP with a tax credit.
• Short-Term Health Insurance: Short-term health insurance is available year-round and offers fast approval. However, these plans usually don't cover pre-existing conditions and have limited benefits.
• Fixed-Payment, or Fixed-Indemnity Plans: These plans are an alternative when short-term plans are not an option. They often cover people with pre-existing conditions but have daily limits on how much they will pay for any medical situation.
• Cost-Sharing Services: Cost-sharing services are not traditional insurance but qualify as an ACA-approved alternative. These plans can keep medical costs manageable as they are spread out among many participants, but the costs might be greater than what a child's care would be out-of-pocket.
• Travel Health Insurance: In some cases, a travel health insurance plan may be sufficient for a child joining a group trip. However, many travel insurance policies require primary coverage to cover expenses after travel benefits run out.

It's important to note that the availability and specifics of these alternative insurance options may vary depending on your location. Be sure to research and compare different plans to find the best fit for your newborn's health and well-being.

Frequently asked questions