Last week, we got a call from a lady who had several questions about maternity and newborn coverage. She lives here in Colorado and has her health insurance with one of the state’s large, reputable carriers. She had called her health insurance carrier to see how maternity coverage works (it’s a group policy) and the person she spoke with told her that her policy wouldn’t cover the baby after it’s born, since the baby isn’t named on the policy as a member.
Huh?
Colorado law requires health insurance carriers to add newborns to a parent’s policy as of the date of birth, with no medical underwriting. This automatic coverage is good for the first 31 days after the baby is born. In order to continue the baby’s coverage after the first month, the carrier has to be notified of the new addition to the policy within the first 31 days after the baby is born. No underwriting is allowed as long as the carrier is notified of the baby’s birth within that time frame.
In order for this to work, at least one parent has to have health insurance in place at the time of the baby’s birth. If the parents are uninsured at the time of the birth and then apply for health insurance after the birth, the baby’s eligibility will depend on whether the parents are applying for coverage too. If they are (and assuming that at least one parent meets the underwriting criteria and will be approved for coverage), they can apply at any time and the child’s coverage is guaranteed issue – but the price can be increased during underwriting. If the parents are applying for a child-only policy for the baby, they can do so during the general open enrollment periods (January and July are the months that Colorado has designated as open enrollment for child-only policies) or in the first 30 days after the baby is born (this is a “qualifying even” open-enrollment window). In either case, the baby’s policy will be guaranteed issue but the premium can be increased during underwriting.
Incidentally, the law that requires health insurance carriers to add newborns to either parent’s existing policy without underwriting is the reason that “expectant parenthood” is cause for decline on new individual health insurance applications for both men and women. Although most people understand why pregnancy is a pre-existing condition that will cause an application to be decline, people are often perplexed as to why carriers also decline expectant fathers. This is the reason. A newborn – even a very sick one in need of lots of expensive care – can be added to either parent’s already-in-force health insurance policy with no underwriting as long as the addition is made during the first 31 days of the baby’s life.
Back to the original point here. The lady who called us had been given very inaccurate information over the phone by her health insurance carrier. She already has the plan in place, which means that when her baby is born, she can add the child – with no underwriting – to her policy by simply notifying the carrier of the baby’s arrival. With both of our boys, all this required was a phone call to our carrier letting them know the name of the baby and the date of birth. Insurance cards arrived in the mail the next week, and no further information was needed.
I hope this helps to clarify the issue. When in doubt it’s always a good idea to look for official documents that detail coverage info and regulations. The Colorado Division of Insurance has a lot of good information on their website, and you can also search for specific Colorado laws that pertain to your situation. And always be sure to read your health insurance policy – or at least file it in a safe place so that you can find it when you do need to read it.
