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  1. #1
    Join Date
    Jan 2009
    Posts
    3

    Insurance coverage for baby; mother quitting work

    What is the name of your state (only U.S. law)? Mississippi
    Main Question:
    If you add your child to the mother's policy within 31 days, and then she quits her job after paying the premiums for that month, will the newborn care in the hospital be covered?

    Background:
    My wife has insurance coverage through her work. Unfortunately, I don't know all the details as to the plan, but they pay for her coverage pre-tax. In March we will be having our second child, at which time, she is not planning on returning to work after her maternity leave. Our first child is on my insurance plan through the MS State University (I am a student), but it only allows you to buy coverage per semester, and we would have to buy it from January to cover the child. This doesn't cover any of the hospital bills at birth, however, as we found out with our first child, because the insurance company informed us that coverage can only be done through the mother's insurance. However, her premiums for an additional child were too high for us to pay. I know many of you are thinking "check out CHIPs, WIC, Medicaid, etc.", but they go by the last month's paystubs, which are too high, until my wife quits work.

    So, we are thinking of enrolling the child when he is born on my wife's insurance plan and paying the additional premium (~$250 /mo) while she is on maternity leave, and then she will quit work. There is no kind of penalty or anything for this, or any type of non-coverage of hospital costs, because the child was not covered long enough is there?

    Then, enroll both of our children in the CHIP program after my wife has been on maternity leave for two months, then quits work (my other son's insurance will also end in May, about the same time).


    Is this a doable strategy?, or does any one have any additional information that we need to consider?

    Any information is appreciated.

    Thanks


  2. #2
    Join Date
    Feb 2006
    Location
    Philadelphia, PA
    Posts
    36,606
    The only issue is that by choosing not to return to work after FMLA, she may be required to pay her EMPLOYER'S portion of the premium for that month for both her and the baby. But there would be no issue with coverage and both of them would qualify for Cobra after employment terminates as well.

    Did you double check with your school that you definitely can't add coverage mid-semester in the case of a birth?


  3. #3
    Join Date
    Jan 2009
    Posts
    3
    Thank you for the reply. As for your question, I did discuss that option when we had our first child, and they said I could add him, but I would have to pay the entire semester premium because they do not offer any prorated rates. Also, as I stated in my first post, even if he got covered on my insurance, they would not cover the actual hospital expenses...this is because they do not cover well-baby care. The only exception is for a new born, they will cover the first 48 hours of routine newborn care according to the policy, except when I called about this option they said that only applies if the mother is on the policy. This seemed unfair to me (and maybe even some type of illegal sexual inequality), but I called and spoke to several 'levels' of the company, United Healthcare Student Resources, on the phone and after much debate, they stood by this opinion.

    Any additional information would be appreciated.

    As for repaying the employer's portion, would that be at the discretion of the employer or the insurance company (in my wife's case, BlueCross BlueShield)?
    Because the employer is aware of our plans and from all accounts is okay with them. Although he of course wishes she was continuing and is hoping for some type of part-time, on-call type assistance in the future, we have been completely upfront with him on our plans.


  4. #4
    Join Date
    Nov 2001
    Location
    Massachusetts
    Posts
    38,322
    Ask your health insurance carrier. We haven't read your policy.


  5. #5
    Join Date
    Jan 2005
    Location
    Where you can copy from my work
    Posts
    30,128
    Quote Originally Posted by cbg View Post
    Ask your health insurance carrier. We haven't read your policy.
    That's what I always think when I see these threads.


  6. #6
    Join Date
    Jan 2009
    Posts
    3
    Thanks for the advice. Unfortunately, getting any information is a lot like pulling teeth. My wife works at a small satelite office, which is just a branch of another small company (i.e. 10 employees total). When we try to talk to the insurance carrier about any information on our policy, even the premiums for adding our new baby, they tell us that we must go through the company representative to discuss any information about the policy. Then, that creates a problem, because the company person always says just call the carrier and find out. So, after a few rounds around the merry-go-round, we get a few answers at a time....one side will give us a sliver of info, then tell us they can't give any more, and then the other side will do the same.

    So, I was really trying to get general information, or that which would be customary in most instances. I thought I may be able to at least get a couple of ideas of what some of the possible scenarios would be under this same situation, and know that I would probably fall into one of those categories.

    Thank you for your responses.


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