Having a baby is a life-changing event. Before your baby is born, you will probably be busy attending baby showers, decorating their room, and buying furniture and clothing. You will have a million things to do to get ready, and you don’t want to forget anything. This is especially true for healthcare insurance. As soon as you go into labor, you will want to have the security in knowing that your baby is covered when they decide to enter the world. Adding a baby to your health insurance doesn’t have to be difficult.
Enrolling your new baby into a healthcare plan is the first step. When you have a significant life change, standard enrollment periods do not apply. Whether it’s through your employer or the state healthcare plan, you will be permitted a specified period of time to enroll your child.
The first step to getting your baby on your health care plan is to notify the insurance company. The hospital will not contact them for you. This may involve speaking to the human resources department at your place of employment, calling the insurance company directly, or making a change to your current plan online.
Typically, you will have 30 days from your baby’s birth to enroll. The policy will then be retroactive to their birthdate. Do not miss the month-long enrollment period. It will result in costly medical bills, as you will have to wait until your healthcare company’s next annual enrollment date to add your child.
Having insurance through your state or national healthcare exchange means that you will be granted a Special Enrollment Period (SEP) for your new baby. Having a child is called a “qualifying life event” and gives you another window in which to enroll. You will be given 60 days to add your baby to your plan, twice as long as most private insurers.
Changes Under the Affordable Care Act
Certain living and employment situations can create complications for your new baby’s health care. As of 2014, the Affordable Care Act requires that health insurance providers follow the same standards.
Under the Affordable Care Act (ACA), your parents’ health care insurance through their employer can cover you until you turn 26. Keep in mind that the law does not require the employer to cover your parent’s grandchildren, only their children (you).
The ACA has required that all individual and small group health plans offer the same Essential Health Benefits. There is a list of services and items in ten specified categories that must be included in all insurance plans. One of those categories is maternity and newborn care. You will be covered for the following doctor visits and tests:
- Preconception and prenatal care visits
- Rh incompatibility screening: Rh is a protein on the surface of your red blood cells. If you do not have Rh, your blood might be incompatible with your baby’s blood. You will have to take certain precautions while pregnant, like getting injections of Rh immune globlin.
- Anemia screening at your first prenatal care visit and during pregnancy
- Gestational diabetes test between 24 and 28 weeks pregnant
- Tests for infections like hepatitis B, STIs, and urinary tract infections
- Counseling for breastfeeding
Once the baby is born, you will be covered for the following:
- Screening for hearing issues, sickle cell anemia, hypothyroidism, phenylketonuria
- Medication to prevent gonorrhea infection of the eye
- Blood pressure, vision, development, behavioral tests
- Screening for autism
- Other tests for issues the child may be at a higher risk for like tuberculosis
Failure to purchase any for of healthcare insurance for your child will result in penalties. In 2014, the fees were $47.50 per child, $95 per adult, and up to $285 per family. If you have a larger income, the fee could be as much as 1% of your total income. In the future, these fees may increase.
When you add a new baby to your health insurance, your premiums will increase. Babies have many doctor visits, immunizations, and other exams during the first few years of life, and this costs money.
Consider contacting your state’s public health department if you are having financial difficulties and need assistance paying for your new child.
Medicaid is an option for those who are unable to financially support their pregnancy. In fact, over 40% of all births in the United States were financed through Medicaid. The coverage includes help for prenatal care, pregnancy, labor and delivery, and 60 days of perinatal care postpartum. Once the child is born, he or she will still be covered under Medicaid until their first birthday.
The federal government also funds the Children’s Health Insurance Program (CHIP) under the umbrella of Medicaid. The program provides coverage to children in low-income families. In order for your new baby to qualify under your state’s regulations, your income must be (on average) 241% of the Federal Poverty Level. This is about $44,700 per year for a family income. Children in the program receive screenings, diagnosis, and treatment.
Once you have selected a health plan, be sure to review your child’s coverage. You’ll want to know which doctors are in-network, find a medical office that you feel most comfortable with, and keep up with your child’s checkups and vaccines.
If you have additional questions concerning your baby’s health insurance, alert your insurance agent today. You can also find out more about the federal rules and regulations at the Health Care Marketplace and the Department of Labor.
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