Policies for Newborn Coverage - Effective 01/01/2014
Adding a newborn to coverage (applies to all plans, including HMOs):
- Newborns must be added the first of the month of the child's birth. Members have 30 days from the date of birth to enroll a newborn in coverage. An Insurance Change Form must be completed and submitted to the Coordinator or EGID.
- Premiums must be paid for the full month of the child's birth.
- When one or more eligible dependents are currently covered, a newborn must be added to the same coverage, unless there is proof of other group coverage. Proof for current employees must be provided to the Coordinator. Proof for a retired member must be sent to EGID.
- When a newborn is added to coverage, all other eligible dependents must be enrolled in coverage if they are not already enrolled. Members can waive health and/or dental coverage for their spouse.
- Members can request coverage for a newborn grandchild by completing an Application for Coverage for Other Dependent Children. Coverage for a grandchild is effective the first of the month following the receipt and approval of an application and payment of premiums. Coverage is not retroactive to the month of birth, except in the case of a newborn, in which coverage is effective the first of the month of birth.. After 30 days, a retired member cannot add a newborn to coverage without a qualifying event.
- A Social Security number for the newborn is not required at the time of initial enrollment, but must be provided when it is received from the Social Security Administration.
Accepting the HealthChoice Newborn Limited Benefit when NOT adding a newborn to coverage:
- There is no additional premium for the Newborn Limited Benefit. See Plan Details below.
- The HealthChoice Newborn Limited Benefit is subject to the annual deductible coinsurance, and Plan limitations. See Plan Details below.
- A newborn has limited coverage for a routine birth for the first 48 hours following a vaginal delivery or for the first 96 hours following a C-section delivery without an additional premium.
- Enrollment of other eligible dependents is not required.
- The Newborn Limited Benefit applies only if the mother or father of the newborn is covered under a HealthChoice health plan.
Plan Details (when NOT adding a newborn to coverage):
- Aetna HMO, CommunityCare HMO and GlobalHealth HMO - A newborn is covered for 31 days without an additional premium.
- HealthChoice Newborn Limited Benefit-
- A newborn has limited coverage for a routine birth.
- There are no benefits for services in addition to a routine hospital stay if the newborn is not enrolled and premiums are not paid for the month of the birth.
- Members are responsible for any charges over and above the Newborn Limited Benefit regardless of the facility's Network or non-Network status. A separate calendar year deductible and coinsurance apply.
Declining the Newborn Limited Benefit:
A Newborn Benefit Waiver must be completed to exclude a newborn from the Newborn Limited Benefit.