Newborn coverage in New York State

[JJNYC]

What is the name of your state? New York

As I understand it, insurance companies are required to provide newborn coverage under the mother's insurance for 30 days even if the newborn is not added to the plan within 30 days. At least in 49 states they are.

As I'm find out, New York State does not require this of insurance companies. However, unless I'm reading the following incorrectly, they ARE requried to cover the newborn for 48 hours (or 96, depending on the type of delivery) even if the newborn is not added to the coverage within 30 days. Am I missing something here? Thanks!

(From NYS.gov):

1. Pursuant to New York Insurance Law § 4303 (McKinney 2007), coverage of the mother and newborn infant is required for at least 48 hours after a vaginal birth and at least 96 hours after a caesarean birth.

2. In accordance with New York Insurance Law § 4305 (McKinney 2007), if the insured parent does not add the newborn infant to the coverage within 30 days, the newborn infant would be covered only for the period specified in Insurance Law § 4303.

 

[ecmst12]

What is your specific situation? It depends on the specific type of plan whether state law applies or not.

 

[JJNYC]

What is your specific situation? It depends on the specific type of plan whether state law applies or not.

To be honest, I'm not really sure. It was not an HMO, and my wife/her employer were certainly paying a good amount for it each month through Oxford Health. She already had one dependent on the policy.

She actually canceled the insurance around 90 days after the birth as she started a new position with health insurance.

Oxford has paid all of her claims from the delivery as whe was still insured, but it refusing to pay the newborns' costs.

 

[ecmst12]

If the company was self insured, then state laws do not apply. MOST companies are self insured, meaning they provide the money to pay the claims, and the insurance company only manages the benefits. If the baby was never added to the policy, then they would not have to cover any bills for the baby, only for mom.

 

[JJNYC]

If the company was self insured, then state laws do not apply. MOST companies are self insured, meaning they provide the money to pay the claims, and the insurance company only manages the benefits. If the baby was never added to the policy, then they would not have to cover any bills for the baby, only for mom.

Thanks very much! I'm pretty sure they were not self-insured as it was only a 5 person shop, but I'll confirm.

 

[rdexter101]

I see that this law is specific to HMO does this apply to non-HMO i.e Experience rated and Community rated PPO/POS contracts as well and if so what is the Insurance Law?

From NYS.gov):

1. Pursuant to New York Insurance Law § 4303 (McKinney 2007), coverage of the mother and newborn infant is required for at least 48 hours after a vaginal birth and at least 96 hours after a caesarean birth.

2. In accordance with New York Insurance Law § 4305 (McKinney 2007), if the insured parent does not add the newborn infant to the coverage within 30 days, the newborn infant would be covered only for the period specified in Insurance Law § 4303.

 

[ecmst12]

Don't hijack someone else's thread. Start your own thread if you have a question.