You’ll make several trips to the doctor’s office in the first month of your baby’s life. You can avoid wrangling with your health insurance provider (and unexpected medical bills) by understanding how newborn insurance coverage works in the first 30 days after birth. Consider what you need to do in order to get baby insurance, and learning when your newborn health insurance coverage will take effect.
Before Your Baby Is Born: Look at Your Current Coverage
Evaluate both parents’ coverage options.
While the proverbial bun is still in the oven, set aside some time to review your and/or your partner’s respective healthcare plans–especially if one or both of you get baby health insurance coverage through your employer.
Because some health insurance plans limit the number of dependents who can be covered under the same policy, you’ll want to check with your insurance provider to make sure your plan will allow you to add your baby to your plan once (s)he is born. Keep in mind that adding dependents to your plan may raise the cost of your monthly premium, so you may want to ask your insurer if adding dependents to your plan will affect the cost of your premium (and if so, by how much).
Contact Your Insurance Provider (Within 30 Days of Your Child’s Birth or Adoption)
New parents typically have a 30-day window to enroll in, or add a newborn child to, a private healthcare plan. Parents who get coverage through the federal or state Marketplace have 60 days following their baby’s birth or adoption to add their child as a dependent on their policy. In both cases, baby insurance benefits are retroactive, dating back to the baby’s date of birth or adoption.
Why It’s Important to Do This Sooner Rather Than Later
Though you may have a month or two to add your baby to your healthcare policy, it’s best to inform your insurer of your new addition as soon as possible. Some healthcare plans require parents to submit documentation and paperwork within a certain timeframe in order for the cost of your baby’s initial medical care to be covered retroactively.
If You Have Employer-Sponsored Coverage
If you are enrolled in an employer-sponsored group plan, your HR department or insurance provider may be able to provide you with enrollment or application forms in advance. It can take several weeks to receive your newborn’s birth certificate and Social Security number in the mail; check with your provider to find out if other documentation, such as a notarized letter from your hospital, can be used in the interim to confirm your child’s birth or adoption.
Get Coverage for Your Baby
In order to ensure health insurance for newborn children, most insurance providers require parents to add their newborn baby to their insurance policy within 30 days of their child’s birth or adoption (the sooner, the better). Depending on how you get your health insurance, you’ll need to take action in one of the following ways after welcoming your new baby into the world:
- If you get insurance through your employer: Contact your HR department or the person who administers benefits at your workplace. Let this person know that you would like to add a dependent to your healthcare plan.
- If you (or your partner) have coverage through a private plan: Call your insurance provider directly. A representative can walk you through the process of adding your baby to your plan. The representative will also let you know if adding a dependent to your plan will affect the cost of your monthly premium, and can inform you of any further steps you need to take to ensure your baby has coverage.
- Informing your provider through your state’s Obamacare health insurance exchange: Under the Affordable Care Act, having a baby is considered a “qualifying life event,” entitling you to a special enrollment window during which you can make changes to your healthcare coverage. Parents have 60 days to enroll their newborn as a dependent on their plan. As long as a parent or legal guardian does this within 60 days of the baby’s birth or adoption date, coverage will apply retroactively. Uninsured parents can enroll themselves and their newborns in a new plan at this time.
To avoid a delay in baby insurance coverage, new parents should report a birth or an adoption to their state or federal Marketplace as soon as they can. Consumers can report this event online at HealthCare.gov or by calling the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325). Parents should not report these changes by mail.
Newborns’ and Mothers’ Health Protection Act of 1996
The Newborns’ and Mothers’ Health Protection Act of 1996 requires health insurance plans to cover the cost of care for mothers and their newborns during and immediately following the labor and delivery process. Under this law, mothers and newborn children are entitled to a 48-hour hospital stay following childbirth (for vaginal delivery) and a 96-hour hospital stay (if the baby was born via cesarean section). The law applies to parents with any kind of creditable healthcare coverage.
If a mother’s health insurance plan provides coverage for a longer hospital stay, this is certainly permitted. Prior authorization is not required in order for the cost of the hospital stay to be covered, though some providers may ask the mother to notify their insurer of their due date and childbirth plan.
Getting TRICARE for Your Child
If you’re a parent serving in the military, you can get TRICARE for your child in two steps:
- Register your newborn or adopted child in the Defense Enrollment Eligibility Reporting System (DEERS). You must enroll in DEERS to receive TRICARE coverage.
- Choose a TRICARE healthcare plan and enroll your child. Note: parents don’t need their child’s Social Security number in order to register their child in DEERS. Once the SSN for their child is issued, parents can update DEERS with that information.
Parents and legal guardians must register their child in DEERS within one year (365 days) of his or her birth or adoption.
Key Points: Baby Health Insurance & Health Insurance for Newly-Adopted Children
- All state and federal Marketplace health insurance plans, as well as Medicaid and CHIP plans, cover the cost of prenatal care and childbirth/delivery. This is true–even if a woman was pregnant prior to enrolling in a plan and her coverage taking effect.
- Adopting a child or having a baby counts as a qualifying life event, entitling parent(s) to a Special Enrollment Period. During this period, parents can make changes to their insurance plan, or enroll in a new one.
- Parents have a 30-day grace period (or a 60-day grace period for Obamacare plans) to add their baby to their health insurance policy. As with most deadlines, the sooner parents do this, the better.
- As long as parents are insured and add their newborn as a dependent to their healthcare policy within 30 days of their child’s birth or adoption, the newborn will be covered from the moment of his or her birth.
- Health insurance plans are required by law to cover care for mothers and their newborns during and immediately following the labor/delivery process.
- Affordable Care Act health insurance for newborns and children is guaranteed issue. Insurance companies cannot reject an application or make children pay more due to pre-existing medical conditions.
Taking the Next Steps
Check with your current health insurance policy to see what rules apply to newborn children, and check if there’s any necessary steps you must take to ensure that you have baby insurance for your newborn.
For More Reading:
- What Are the Essential Health Benefits Under Obamacare?
- Buying Health Insurance for Children Under 18: A Guide
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