Health Care reimbursment for my newborn

[Alzee77]

What is the name of your state? CT

I am an independent consultant who contracted with a consulting firm earlier this year for employment. During this time, the consulting firm provided health insurance which I paid bi-weekly premiums. Also, during that time my third child was born. However, I failed to add my baby within 30 days of his birth but no later than 40 days. I've been notified by the insurance company they will not pay the hospital claims ($6, 000) because of this timing issue.

I do no feel this is fair. Do I have a legal case to sue?

Thank you,
Alzee77

 

[Beth3]

If you received an insurance booklet or plan document when you enrolled for coverage, I fully expect it spelled out in there what a participant is required to do when a new legal dependent occurs and the time limit to add them for coverage. Assuming that is the case, then no, you don't have any basis to sue. The insurance company provided you the information; it's not their fault if you didn't read it or failed to notify them of the new baby timely.

 

[Alzee77]

Beth3, thank you for your reply. I just reviewed my employee handbook and signed copies of my application forms and no where is that spelled out.

 

[cbg]

In my state, it is the law that a newborn must be carried on a parent's plan regardless of anything for 30 days; however, if the newborn has not been added to the plan by the parent using the standard enrollment procedures of the policy by the end of the 30 days, the newborn is NOT covered for any time past the initial 30 days and can only be added at the next open enrollment period. I'm sure other states have similar laws.

If your plan is under a Section 125 plan (your premium portion taken pre-tax) then it is the law, regardless of what state you are in, that you may add a new dependent, regardless of whether we are talking about birth, adoption or marriage for 30 days after the qualifying event (in this case, it would be the child's day of birth) but after that, you have to wait for the next open enrollment period.

It is standard practice, regardless of whether it is spelled out in your policy or not, to give a new parent 30 days to add a newborn.

Did you ask anyone what the procedures were? Or did you just assume you could add the baby whenever you got around to it?

Whether it is fair or not, I do not see that you have any legal standing to sue. It was YOUR responsibilty, not that of anyone else, to determine how long you had to add the baby and do it.

 

[Beth3]

Alzee, that information is not going to be in your employee handbook or on copies of the application forms. You need to look at the actual Plan Document or insurance booklet you were given when you enrolled for coverage. Those are the legal documents that must contain all the in's and out's of the health plan.