Newborn baby health insurance confusion

[bogiegifts]

What is the name of your state? Georgia

I am due to give birth to our 2nd child in 5 weeks. My husband's group coverage for a family is VERY expensive and we just can't afford to put everyone on it. Since I was pregnant when he started his new job and attained new group coverage I am covered. We have decided to put our children on private policies. Currently our 2 year old is covered on her own private policy. We've now started the process for the new baby only to find out the company we want to use won't let us put the new baby on until the first of the month after he is born. They will not cover him effective his birth date! We don't know what to do because we cannot afford my husband's group coverage (it is over $1,000/month for the 4 of us compared to $400 for he and myself).

We have called our current group company and they said that if we don't put the baby on the policy within 30 days they will not cover him at all even from the time he is born. My husband said he heard something about Georgia law stating that our insurance company has to cover the baby for the first 31 days of his life. My question is if this is indeed true then if we don't put the new baby on our insurance will we be charged his hospital bills after the 30 days has passed? I'm sure we will be, but I'm just trying to figure out what our options are.What is the name of your state?

[moburkes]

Your insurance company is correct.

QUESTION: Are there any other conditions or circumstances other than pregnancy which the insurer cannot limit coverage due to pre-existing conditions?

ANSWER: Yes. Newborn or adopted children are not subject to pre-existing condition limitations if added to the policy no later than 31 days following birth or adoption. Also, genetic information in the absence of a diagnosis cannot be considered a pre-existing condition.

From here:

[url]http://www.gainsurance.org/INSURANCE/HealthFAQ.aspx[/url]

[TIMMAAYY]

Barring any serious issues with the baby's health, you should be fine.

Your current group plan covers the birth of the baby under your maternity coverage, as well as any complication associated with the birth ( if any.... knock on wood ).

The current plan will cover the baby until it is released from medical care, then go to the individual. Your best option is this:

1) Enroll the baby. Take the hit for ONE MONTH....

2) Sign up for the individual policy for the baby, with as soon of an effective date as possible.

3) Fill out a "Change Enrollment" form for your group insurance, and drop the newborn off the group once the individual policy is in hand.

The "qualifying event" items are for enrollment... not DISenrollment. You don't have to wait until the end of the year or "open enrollment" period to drop a dependent from your plan.

Good luck.

[moburkes]

They don't want to pay the group premium. They're also assuming that the baby will be healthy.

[TIMMAAYY]

That's why I said take the hit for one month... ONLY. This will ensure that the baby is covered, barring any gap at all if it were to arise. If the baby is born on the first of the month, and they have to wait two or three weeks to the first of the NEXT month to get the individual coverage, there may be a gap from the group plan.

Take the hit for one month only. Then drop it and go to individual. Otherwise, you are taking a chance on a short period of time that can be a crucial time for the newborn.

[moburkes]

I meant, insurable, under the individual plan.

[TIMMAAYY]

If the newborn has issues and can't get an individual policy, take off ALL the healthy dependents and go individual. The writer seems to already understand than individual policies are much less expensive. As long as the husband is on the plan, he has coverage and doesn't effect the group's "quota" for participation. If mom and all the kids are healthy, put them on individual. If she would decide she wants to have another child someday, she can go back on the group at open enrollment and they can't pre x her for any of it. Also, if dad were to lose his job, those on the individual plans have no worries.... they own the policy. They keep it as long as they pay the premium.

[moburkes]

You lost me. The only dependent is mom. The others would already be individual. What would you do with the sick daughter?

[TIMMAAYY]

She already has one daughter on an individual plan, the 2-year old daughter.

If MOM is healthy too, she should be on an individual policy along with the 2 year old. If the new baby is healthy, they should add it to the individual "family" policy as well. Mom would be primary, the 2 children would be dependents on the individual plan.

Dad, stays where he is... there are no rules regarding dependent coverage on group plans. They love to let you THINK you have to have them on there, since the carriers make a boatload of money that way. In reality, the only person in a group plan who needs to be enrolled in it ( barring the participation rules for minimum enrolless ) is the employee. None of the dependents have to enroll in the "group" plan.

If the daughter is not able to qualify for individual, put her on the group plan and remove Mom.

[moburkes]

My question is if the new baby is NOT healthy, not if the newborn IS healthy. That's why I didn't understand post 7.

[TIMMAAYY]

If the newborn is not healthy, she'll have to go on the group. In order to save money, and IF mom is healthy, then remove Mom and put the unhealthy baby on the group plan.

Mom and the 2 year old would be on individual. Dad and the newborn would be on group.

[ecmst12]

To ignore the whole argument, once the baby is added, dad will NOT be able to drop coverage for him/her until the next open enrollment period. You CAN NOT add someone onto a section 125 group plan for only one month; they are on until the next open enrollment or a "qualifying event" happens.

[TIMMAAYY]

No, you don't need to wait for any qualifying event to REMOVE dependents... only for enrolling. You can elect to drop a dependent at any time.

[cbg]

Technically, that's true. What you can't do is stop having the deductions taken until open enrollment.

[ecmst12]

So if you'd want to drop coverage that you're still paying a crapload of money for, sure go ahead!