Your baby is on her way, your insurance plan covers maternity costs, so all is well, right? Maybe not, according to the U.S. Office on Women’s Health, at least not if you haven’t taken additional steps. You must add your baby to your policy or secure other coverage. Your insurer isn’t obligated to automatically cover your baby if you don’t officially request the coverage.
The Newborns’ and Mothers’ Health Protection Act
The federal Newborns’ and Mothers’ Health Protection Act, sometimes called the Newborns’ Act, covers you and your baby for a couple of days after delivery. If you have insurance, plans that provide maternity benefits are obligated to cover your hospital stay without restriction for the first 48 hours -- 96 hours if you deliver by cesarean section. The clock begins ticking with the time of your baby’s birth, not necessarily when you arrive at the hospital to deliver. The insurer can’t force the hospital or your doctor to discharge you or your baby sooner, at least not without your consent.
Many states have their own version of the Newborns’ Act. If yours does, look into its terms because state programs usually supersede the federal act. The exception is if you have self-insured coverage. Your plan is self-insured if your employer pays for your healthcare directly or through a third-party administrator who handles claims rather than pay premiums to an insurance company. Self-insured plans are covered by federal law.
The Newborns’ Act doesn’t address long-term coverage, so notify your carrier that you’re having a baby in advance of your due date. Find out what you must do to add her to your policy when she arrives and select a pediatrician from among those available on your plan. You’re not necessarily out of luck if you don’t make these arrangements before her birth, but you may have limited time afterward to do so -- usually 30 days, although some plans are more generous. If you miss the deadline, you’ll have to wait until the next open enrollment period. If you act within 30 days, coverage should be retroactive to her date of birth.
If you’re not enrolled in a health plan provided by your employer but you’re eligible for one, you can often use the blessed event to sign yourself up within 30 days, too. The birth qualifies you, your baby and your spouse for special enrollment without waiting for the next enrollment period.
Affordable Care Act Provisions
If you’ve purchased coverage through the Affordable Care Act’s marketplace, the rules are much the same. The birth of your baby is a qualifying life event that allows you to add her to your plan during a special enrollment period. You have a little more time than if you’re covered by an employer-sponsored plan -- 60 days. If you don’t do anything -- either cover your child through an employer-sponsored plan, through the marketplace or through state services -- you’ll have to pay the Affordable Care Act penalty when tax time rolls around.
State and Government Programs
Many states have expanded Medicaid coverage for individuals with incomes up to 133 percent of the federal poverty level. If you can’t afford marketplace insurance and you’re not eligible for an employer-sponsored plan, ask your health care provider what coverage is available in your area. Low-income children under age 18 are eligible for Kids Now coverage in all 50 states. You may be eligible for benefits for yourself, too, based on your income.