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Adding a Baby to Your (or Your Spouse’s) Plan

We’ve spent a great deal of time describing the various “windows” or time frames within which you must make decisions and process enrollments to maintain healthcare coverage. We’ve also described life events which allow you to enroll for coverage outside an annual enrollment period. One of those qualifying events is the birth and/or adoption of a child.

The “window” for adding a child to your Plan is typically 30 days from the date of birth but there are exceptions. For some Plans it is 60 days. Be aware of this deadline and determine what information you must provide for your child to be added. The objective here is to have your child added so that claims for services for the child are covered. The addition of a child will be made retroactive to the date of birth. Also, the addition of a first child will always change the premium and your contribution. If you already have coverage through an adult plus children premium structure or a family premium structure, the birth of an additional child may not change your premium or contribution.

Our typical advice, leave nothing to chance, applies when adding a baby or an adopted child to a Plan. Unfortunately, those who assume that a newborn is automatically added to insurance coverage because the mother’s claims for obstetrics and delivery were covered, may leave the child at risk for a gap in coverage and/or a claims mess.

Historically, one adds a child to coverage by providing the child’s social security number and birth certificate to the necessary party (and adoption papers in the case of adoption). The pandemic era has resulted in some flexibility in this regard since wait times to obtain documents from the government have occasionally been longer than in the pre-pandemic era, but you still need to notify the necessary party of the child’s birth timely. For a newborn, the hospital typically initiates the application for a Social Security number but it is a parent’s responsibility to follow-up with their local office if the Social Security card isn’t generated. A parent must apply to obtain a birth certificate from the local jurisdiction where the birth occurred. Again, once processed, your child’s coverage will be made retroactive to his or her date of birth.

How you add a child is determined by how you obtain your coverage. If your coverage is through an employer, Human Resources (or some other administrative contact if the business does not have an HR Department) will be able to guide you. If you purchased a Plan through the Marketplace, you need to contact healthcare.gov or your state-based Marketplace. If you are eligible for a premium tax credit, the addition of a child will likely affect that too. If you obtained your coverage through a broker, contact the broker to add a new family member to your Plan. If you applied for coverage online yourself directly with the insurer, contact the insurer to learn about the process to follow.

It is common for parents to both be employed with each parent covered by their respective employers. In this case you want to carefully consider which Plan should cover the child. It is much less common today for a child to be covered on both parent’s plans but that may be desirable depending on the circumstance. Should a family decide to cover children on both parent’s separate Plans, the birthday rule applies, meaning whichever parent’s birthday comes first in the year is the primary coverage and pays first. The second parent’s coverage would be secondary and pay after the primary coverage pays on a claim.

Be on the lookout for a new identification card from the insurer. Sometimes a Plan will generate a card for each child and sometimes the children are shown as dependents on the parent’s card who is the subscriber. Provide the proper identification to every physician office or other provider caring for your child. Also, please check that the child has been properly added to your online insurance company portal and verify that claims are being processed correctly.

The birth or adoption of a child is an exciting time, with many things to check off the to-do list, some more enjoyable than others. Please do remember to be particularly conscientious about getting the child health insurance coverage and, as always, leave nothing to chance.