About Newborn Enrollment

What is the name of your state? South Carolina

Here is my situation. I gave birth to my son on April 26th 2007 and my husband's employer didn't give us the enrollment paperwork until June 6th 2007. We have cigna health insurance and we didn't know about the 31 day time limit that they place on newborn enrollment. We were never notified of this. Of course, now, my new baby was denied insurance. I heard of a federal law requiring that if cigna paid for my maternity care and giving birth, then they have to pay for everything connected to the newborn within that 31 day period until denial or approval is established. Is this True? I called cigna and quoted this law since they were refusing claims sent by the hospital and my baby's pediatrician. They said that they understand the federal law and that since my husband's company didn't enter my baby's name in the system, they couldn't pay for anything until he was entered. I talked to my husband's corporate office and they say that they can not put his name in unless he is approved. If this Federal Law really exists, how come it isn't helping us? Please, anyone, give me some advice!! I can't afford to pay all of these bills on my own, that is why we have insurance and my husband FAILED to step up and make sure that insurance was settled after he was born!

[fairisfair]

use your search feature and the words newborn enrollment

[url]http://forum.freeadvice.com/showthread.php?t=364090&highlight=newborn+enrollment[/url]

I found several other cases similar to yours, the link above is one of them, that have already been discussed on the forum, you may find good information there.

I was hoping to get advice for my individual, unique situation.

Originally Posted by fairisfair

use your search feature and the words newborn enrollment

[url]http://forum.freeadvice.com/showthread.php?t=364090&highlight=newborn+enrollment[/url]

I found several other cases similar to yours, the link above is one of them, that have already been discussed on the forum, you may find good information there.

[TIMMAAYY]

Typically, maternity coverage is for the actual birth of the child, any complications related to the birth of the child, and medical care for the newborn until they are "released" from medical care by the doctor.

Either way, you have missed the 31 day mark.

The agent should get all over this for you to help you out. The carrier obviously new there was a newborn on the way, but as someone stated above, for all they know, you could have been planning to put the newborn on a different insurance policy.

If I remember correctly, if you as the spouse were covered and the baby was added, the baby would be covered retroactive back to the date of birth. If you as the spouse were not covered and the baby was added to the plan, it would be retroactive to "release from medical care" at the hospital.

I don't think they HAVE to do anything, but I would have HR get all over the agent in the case and see if they can get this fixed for you. I've gone to bat for others in the past and have been successful after explaining the situation to the carrier/group rep/agent.

From HIPAA: and from this link:

[url]http://hippo.findlaw.com/newborn.html[/url]

`(c) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE COVERAGE IN CERTAIN

STATES-

`(1) IN GENERAL- The requirements of this section shall not apply with respect to health

insurance coverage if there is a State law (as defined in section 2723(d)(1)) for a State that

regulates such coverage that is described in any of the following subparagraphs:

`(A) Such State law requires such coverage to provide for at least a 48-hour

hospital length of stay following a normal vaginal delivery and at least a 96-hour

hospital length of stay following a cesarean section.

`(B) Such State law requires such coverage to provide for maternity and pediatric

care in accordance with guidelines established by the American College of

Obstetricians and Gynecologists, the American Academy of Pediatrics, or other

established professional medical associations.

`(C) Such State law requires, in connection with such coverage for maternity care,

that the hospital length of stay for such care is left to the decision of (or required to

be made by) the attending provider in consultation with the mother.
_________________________________________________________________________

In other words, IF SC Law states that release of the newborn from maternity care is up to the provider (doctor) or required to be made by the attending physicianr, then they are considered covered by the mother's insurance until such time as they are released from medical care by that physician.

SC Law:

SECTION 38-71-140. Coverage of newborn children.

(A) All individual and group health insurance policies providing coverage on an expense-incurred basis and individual and group service or indemnity-type contracts issued by a nonprofit corporation which provide coverage for a family member of the insured or subscriber, as to the family member's coverage, also must provide that the health insurance benefits applicable for children are payable with respect to a newly born child of the insured or subscriber from the moment of birth.

(B) The coverage for a newly born child consists of coverage of injury or sickness including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities.

(C) If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that notification of birth of a newly born child and payment of the required premium or fees must be furnished to the insurer or nonprofit service or indemnity corporation within thirty-one days after the date of birth in order to have the coverage continue beyond the thirty-one-day period.
________________________________________________________________________

They don't have to cover "everything" for 31 days, only complications as stated above - medically necessary or medically diagnosed treatment for congenital birth defects or abnormalities; ie complications.

I would still have your HR department, or even yourself, contact the agent and get them to help you, as someone dropped the ball on notifying the carrier "properly" that your new child was to be added to your plan. That's your best case, but again, they don't HAVE to do it for you.

Your worst case? You will have to pay for everything from 48 hours after the birth until now, and you can get your new child an individual policy for very little cost.

Depending on your arrangement with your employer, you may be better off to have your child on their own policy. Certain carriers in group coverage charge quite a bit for adding dependents, where others, if you are already in a family plan with the group coverage, one more child won't change the monthly premium at all. Also, every employer is different as to how they contribute towards the premium and share the cost with the employee. If you have to pay for adding the dependent children yourself, individual insurance may be better and less expensive.

[cbg]

I don't see anywhere in your post where you called and asked what the procedures were to add the baby to the coverage. It's not the responsibility of HR to read your mind and know what your plans are.

[nextwife]

Good heavens. WHY would you not have researched this and had your ducks in a row BEFORE delivery, so you'd know what to do? It's not like there wasn't a BIT of lead time before you delivered. Did you take time to pick out stuff for the nursery? Decor? Bedding?

This is WAY more important and deserved higher priority. I had my paperwork ready to go the day we became parents - just needed to plug in some additional info. Everything was faxed to my HR dept promptly - and I also called HR and confirmed receipt of my document package. You and husband needed to give this TOP priority to make certain you would not miss any cut-off dates. Did you or hubby do any research on the necessary procedure with HR BEFORE delivery?

[ecmst12]

If you missed the window, regardless of fault, the baby can not be added now. If your employer were to do so, they would be violating federal law and risk losing their tax deduction for sponsoring the health plan. You will have to wait until open enrollment.

Unfortunately, your situation is neither unique nor uncommon.