Here's the situation ... which neither my wife nor I were fully aware of until this week ...
Our son was born on 10/21/11, healthy baby boy. My wife and I have a family insurance plan that covers her and my other two kids (I am insured separately). The open enrollment period for her insurance happened to be within the 30-day deadline for adding a baby to the insurance (they required paperwork for her health plan in the middle of November). She filled out the open enrollment paperwork to include our newest son and turned it in to her HR department by the deadline. So, we thought everything was fine -- everybody's insured; payments stay the same; vaya con Dios.
Unfortunately, it appears that "open enrollment" paperwork may not be the same thing as "add a new baby" paperwork. So, even though paperwork including the baby was turned in within the time period, it appears that we may have blown the 30-day deadline for adding a baby to the insurance plan. I'm not sure exactly the ramifications. I don't know if our son's hospital costs for the birth are covered anymore (which could be substantial). I'm not sure if it can be fixed, or how to do so. I know our son is definitely insured staring on 1/1/12 -- the date the new open enrollment paperwork takes effect -- but I'm not what happens in the meantime ... what to expect, and how to fix it.
My wife will be talking to her HR personnel today for clarification. Any suggestions? Anybody have any experience with this kind of SNAFU?
I am in the insurance industry, but am not a health expert. Most groups include a "change of life" clause for childbirth, divorce, marriage, etc. And most health policies the infant is covered under the mothers plan for between 30-90 days. Each is different, and each state is different. It shouldn't be a problem though. The HR person should be able to fix it with a call.
Hope this helped a litte, and congratulations.
Thanks a bunch for the reply.
Does the 30-day infant coverage usually apply even if the infant isn't properly added to the insurance by the deadline? My concern is that the paperwork mistake may retroactively revoke the baby's coverage for the hospital stay. If that doesn't happen, the ensuing couple of months don't really matter much. He can wait until 1/1 for vaccinations and things as long as the birth stuff is covered.
And, if the baby isn't properly added ... is there a way to go back and properly add him without a coverage gap?
It is all going to come down to how your coverage was written, what exactly was signed, turned in, etc. Wait to hear back from HR so that you have a better picture before you worry too much.
In my office, the open enrollment paperwork is the same as the add a dependent paperwork. Presumably, your wife could have added you during the open enrollment period (premium would go up, of course), why not the baby?
Except, unlike at my office, you've got a big gap between the open enrollment and the new coverage effective date. I take it you wouldn't have expected to be covered until 1/1 had she added you during open enrollment. The insurance company could treat the baby no differently.
What's going to happen: All bills will be submitted to your wife's insurance, because the providers will assume she added the baby to her coverage, and they have her insurance info. The insurance company will either pay them or deny them because the baby was covered, or not. If the insurance company denies them, you'll get the bills.
Depending on the efficiency of the providers' billing people (and the birth of a baby involves bunches - the hospital, a pediatrician, maybe an OB for the circ, etc), the process could take months. I had routine blood tests in February and didn't get the bill until September. I didn't get an itemized bill until November.