Dependent Coverage

[Tracy729]

What is the name of your state? Oregon
I'm Having problems with my boyfriends pervious
employer in regards to his medical insurance.
This is the problem
He was employed by Stream International here
in Beaverton OR. He started working there 1/28/03
and his medical benefits started on 5/1/03. We
were expecting our first baby on 5/22/03. On 5/8/03 Stream
announced that his department was being let go
due to the fact that Stream lost there contract with
AT&T and it was effective as of 5/31/03. Jon then
asked about his medical benefits and if Caleb would
be covered once he was born. He was assured by
the HR rep that his benefits would cover Caleb as
a dependent and that he would have to add him on once he was born.(not giving him a time frame)
Jon was told that in order to put him on his insurance we would need his
social security # and a copy of the Birth certificate to do so.
I had to have a C section, since he was 10lb 4oz and to big to come
out normally. Jon was off of work May 22, 23, 26 (for memorial day) 27, 28th
the 29th. He returned back to work on the 30th which was a Friday. My
Insurance with my employer covered 95% of the medical bills. We now
have a small bill of 270.00 I told Jon to contact Stream to get this part
taken care of since they told him, Caleb would be covered. Jon
contacted Stream and they told him today that Caleb was is not
covered since he did not put him on with in the 30 day time frame before
his benefits expired on 6/1/03. We did not get any of the stuff that they
required until June 10th. So we were unable to add Caleb to Jon
insurance due to the fact that we dud not get proof until then. Jon
and I are not in the position financially to pay this due to new baby, Jon
getting a new job, trying to catch up on bills that we fell behind on since
all this has happened to us. From my understanding Caleb is covered
no matter what due to the fact that he was born with in the month Jon
was covered by his insurance. I'm looking for some understanding
on this issue everyone that I have talked to tells me that he is
and that no matter what Caleb is covered

 

[cbg]

I'm sorry, but it would be highly unusual for a new baby to be covered for longer than 30 days without being officially "added" to the plan by the parent. In most states, a newborn IS covered "no matter what" but ONLY for that 30 day period. After that, if the infant has not been officially added to the plan so that appropriate deductions can be taken and the insurance carrier notified that this is a validly covered dependent, the coverage ends.

By your own description they told you that Caleb would have to be added to the plan. If you did not understand how long you would have to do so it was your responsibility to ask.

Was Jon offered COBRA?

 

[Beth3]

Plus, you're also assuming that if he were on his father's health plan, that $270 would be paid by them. That well may be an incorrect assumption.

Many employers' health plans have abandoned coordination of benefit features in exchange for "maintenance of benefits." For example, if the mother's plan is primary and has covered a medical bill at 80% and that bill would also have been paid at 80% if the father's plan were primary, the benefit has been "maintained" and no further benefits are payable by the secondary plan. It's quite possible that the balance on this bill wouldn't have been paid even if your boyfriend had signed up the baby on time.