April 20, 2013,
K.H. asks from Ladson, SC on April 16, 2013
HELP!!! Insurance Unwilling to Cover Newborn Son Based on Some 30 Day IRS Rule
First off, I'm not a Mom, but since Mom's seem to have all the good info relative to kids I'm hoping you'll let me crash the party!... I recently was made a father for the second time, and now, a couple months later my HR people are telling me that I can't have son on my insurance because its been more than 30 days. When my first son was born, 4.5 years ago, I didn't have to file any paperwork (we had United then as now). Whatever the insurance company needed they must have got from the hospital. Hardly a week after my son was born my company sent me to Canada for work. I was in the middle of preparing our house for sale, making preparations to receive my son, negotiating with my company, going through Canadian immigration for a work permit, and having my son. I have NEVER heard of this 30 day requirement. My HR person just kept quoting it and stating that it's in the policy. I always read the info distributed during annual enrollment, but that is from the perspective of what is covered, what are the specific, individual costs (which I'm pretty sure is the case with everyone). That said, I went back and those documents do NOT mention this. I was able to find one obscure form that briefly mentions this. However, you would never read this form unless you were adding someone to your plan (which could quite likely already be beyond the 30 days). I can absolutely NOT have my son be uncovered. I read through the 2009 posts but I'm hoping to find someone with some more recent information. I would truly appreciate any help anyone can provide, especially anyone in the insurance industry.
In response to some of the questions:
Open enrollment is in NOVEMBER, WAY too far down the road.
I think it's great that some of you are well informed on insurance policies, but I was obviously not. I didn't look into this prior to his birth because I didn't think there was anything to look into. As previously stated, I didn't file ANY paperwork for my oldest son and naturally assumed it would be the same.
The bottom line, I truly appreciate any HELP anyone can provide. I KNOW that people have been able to get around this, I'm just looking for some guidance that might help me to do the same.
I would like to send my sincere appreciation to those of you who've provided genuine advice and words of wisdom. As noted, the open enrollment is not until November which does indeed provide for coverage beginning January 1. Which for me is just too long to have my son un-covered.
I've flown the flag just as high as I'm able (which is pretty darn high). This rule was in effect and had been in effect during this event. At the root here is my responsibility to have known about this. This I do not deny. But for those that would lecture, I'm here because I made a mistake and I'm hoping for a way to correct it. I personally find it absolutely ridiculous that there would be any sort of limited window in which to add your legitimate dependents.
Further, I feel that as I was in the middle of a transfer, on behalf of my company, I would fully expect that my support of the company would be repaid in kind.
Never the less, my faith in man kind is rewarded by some of the best people I could hope to work with (a classification most certainly NOT directed toward the opposing HR or Benefits manager). These people agree with me 100% by the way. They have gone so far as to offer a subsidy for third party insurance as a PLAN B. Their PLAN A, however, is to defeat the HR opposition as they find it unacceptable as well.
I do not find insurance confusing, I find it frustrating.
Again, I am very grateful for any/all assistance. Please, if anyone has anything helpful to add I would be eternally grateful.
E.T. answers from Albuquerque on April 16, 2013
You probably won't like to hear this, but yeah - that's the rule. Here's the Department of Labor website that contains more information: http://www.dol.gov/ebsa/publications/newborns.html
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J.W. answers from St. Louis on April 16, 2013
It isn't an IRS rule it is an insurance rule. Open enrollment. Well they may use the IRS's definition of a qualifying event and the time frame to claim a qualifying event.
So, you can only enroll in an employer based insurance during open enrollment unless you have a qualifying event. Birth is one, death, divorce, can't remember them all but you only have 30 days to use a qualifying event.
Sorry but if this was so important to you why didn't you make sure. Even back when there weren't issues of open enrollment I was on the phone with the insurance making sure the little buggers were covered. If I didn't see the new ID cards in two weeks I was back on the phone.
Anyway, there is little you can do except wait until open enrollment and then get him on.
Call your child's pediatrician, get a cash price for his well visits until November and make out a payment plan.
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T.R. answers from Milwaukee on April 16, 2013
K., I hope your new son & family are doing well! Congratulations on being a new dad...
I used to work for a hospital organization, & did billing for them to the insurance companies, so that is where most of my information is based on.
Likely what happened for your first-born is that the hospital was involved in helping you/your wife get your first son covered under insurance. Most often, the mother's insurance is the same one the child will be covered under, so they can help set all of that up in the hospital.
The reasons many hospitals will do this is it ensures that not only the mother's stay will be covered, but the baby's also. (Most often, 2 separate accounts & charges are created, one for the mom up to, including & recovering from the delivery, & the second is for the baby once delivered, itemizing all of their separate care).
As people have already mentioned, there is a standard period of time for people to be added to insurance plans following a significant life-changing event (marriage, divorce, loss of job & subsequent loss of insurance for spouse, birth, adoption...) This is the window of time that someone can be added to an insurance plan outside of the normal "open enrollment" period.
It sounds like you might be beyond that window by a few months. The first thing I want to suggest is to contact the financial counselor department @ your hospital. Find out if any paperwork was ever filled out/filed on your behalf to get your son enrolled... (btw, did you go to the same hospital as the first delivery?). If so, they may have records & documentation to support fighting to get your son enrolled.
If not, ask them if they can offer any help, to either directly get your son enrolled, or offer resources for you to follow up on to do so, or even alternative insurance options if you aren't able to get him enrolled after exhausting all options.
Secondly, set up a meeting with the benefits coordinator in your HR department. Explain your lack of understanding, what the hospital did/did not do that you were expecting (for example, if your first son was covered because the hospital took care of it, you can state that you thought the same thing had taken place), etc. Ask for help, what can they do on your behalf to work with the insurance company. It is possible that HR can move mountains you cannot, because your company is involved in coordinating the benefits.
If you absolutely cannot get your son on your family's insurance until the next open enrollment period, there are still some things you can look into. I don't know all the options in your area, but there are sometimes community insurance plans (if your son has health issues, or your family is not financial secure), or affordable individual plans. If you are financially secure, it might be possible to pull an individual plan for him with a high deductible, to be used only in case of an emergent care need.
Talk to the hospital & your pediatrician. Explain the problem regarding the insurance. Hospitals in SE Wisconsin offer Self Pay discount - if you have no insurance, you get discounted b/t 25 & 45% of the bill. Your hospitals may offer that, or some type of charity care (which requires submitting paperwork & documentation to prove financial hardship, & is then granted either partially or in full based on your qualifying).
Additionally, my father was able to negotiate with his orthopedic doctor a prorated amount for office visits when he was having knee problems & in between insurance coverage (due to divorce) where the doctor charged him only what would be paid by a moderate insurance company. (say the doctor office charges $100/visit, but a large insurance company pays only $45 of that, my dad was then only charged the $45 to pay in full). Your pediatrician may be willing to do the same so that you do not have to forego any wellness visits & milestone checkups.
I know this is a lot of information, I hope some of it is helpful. Start with the hospital, then your HR department. Take notes of everything - date, time, who you talked to (name, company, position) what you asked, what they said, etc. If you get an answer that doesn't seem helpful, ask for their advice on what to do next, what resources they can recommend.
And if it comes to having to cover him yourself until the open enrollment, I would strongly suggest looking into a low-cost high-deductible plan in lieu of being strictly self-pay, just in case of an unexpected emergency.
Best of luck to you & your family! T.
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S.B. answers from Houston on April 16, 2013
I'm an HR professional and we always remind employees who are about to be parents to be sure and enroll their bundles of joy within 30 days. Now, if after we remind them they don't then there isn't much we can do. Especially after a couple of months.
I don't know what was different then to now BUT unfortunately, in the end it is your responsibility to take care of this. They may have been able to help if it was just a day or so but you are saying a couple of months. I don't see ANY WAY around that. It has just been too long of a time between the birth and now. Your options would be to purchase a policy, COBRA (not sure) or go without.
Unfortunately, in the end, you have learned the hard way not to assume anything when it comes to healthcare. Good luck!
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T.N. answers from Albany on April 16, 2013
Well you CAN submit a formal complaint to your ins co for denying coverage. Ask your HR person for a contact name and address. And they MUST consider your plea and give you an answer in 30 days. However, it's not likely they'll reconsider.
Many states provide temporary coverage for children with no coverage. To see if your state offers this and whether you qualify, google something like "SC State provided health care for resident children".
Meanwhile ad him to your policy when you can. Explain the situation to every provider, ask for a payment plan. Most will agree to a schedule.
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V.B. answers from Jacksonville on April 16, 2013
I am not an insurance industry person, so ignore my comments if you are so inclined... but I am a mom who has had 2 babies, and had them added to our insurance policy, and I am pretty much the person who handles that sort of thing in our home--from health insurance, to dental insurance (and orthodontic care) to vision care and life insurance. I am involved in every detail of it in our home.
Every health insurance policy I have ever seen has an "open" period. When is the "open" season/period on your policy? Other than the open period, there are a few very specific life events that trigger the ability to make changes outside of the open period window. Typically they are things like the birth of a child, or an adoption. There IS a time limit to making changes after these events. If you miss it, you have to wait until the next open period. Usually, the life event allows 30 days after to make any changes relative to the event. So, 30 days after the birth of the baby. 30 days after an adoption is finalized. Etc.
I'm sorry that you did not check into this PRIOR to the birth. I know you were busy immediately after, but it isn't like you didn't have 9 months before the birth to look into it.
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J.M. answers from Philadelphia on April 16, 2013
its the same with our company. its pretty standard. Can you contact public welfare and see about J. getting health insurance for the baby? We have CHIP in PA which will cover kids at 40 per month (even if you have your insurance through your work) if you make a decent amount of money or free if you are below a certain level.
When does your insurance renew? You could add him then
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J.C. answers from New York on April 16, 2013
Ask your HR person (very nicely) to say that you mentioned never receiving the cards in the mail and to inquire if you are in the system. When the company says no, they can backdate you due to a clerical error. But, keep in mind that you will owe for the coverage since his birth.
It's not an IRS rule - just an insurance policy rule.
If the answer is no, look into alternate policies that you can buy to cover him until November.
Furthermore, you came here for help so keep the mad tone down. :) You've received lots of help and although you are in need, it's true that ignorance is not an excuse.
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M.S. answers from Washington DC on April 16, 2013
Every insurance company operates a little differently. I had BCBS when my 4 year old was born, and while I did have to call to add him, they did not require me to send any paperwork. I have UHC now, and when my 1 year old was born, I called to add him and was told I had to send a copy of his birth certificate within 30 days or he would not be added.
None of this had anything to do with IRS rules, BTW, its 100% the insurance companies policy.
Not sure you will be able to get around this. I work in the industry - I have my Life & Health licence but work more with disability insurance. However with that said, the industry all works similarly and so I would think your best avenue here is to work with your HR department and get the insurance broker involved. When HR calls and demands solutions from their broker, the broker will then call the insurance company on everyones behalf and try to negotiate a solution so he can keep his client happy. Insurance carriers will fall all over themselves to try to keep the broker happy as he brings them lots of business. You need to get HR on your side first. Ask for a meeting to sit and discuss the issue. Be nice to the HR person of course, but know that if you are a "issue" she needs to get solved, she will hopfully reach out to her broker for help. No guarantees they will be able to get it done, but in my experience this is how most "exceptions" get approved in the insurance industry. You calling the insurance carrier directly will never get you anywhere in a situation like this. The folks answering the phones have no authority to do anything other than what the rule book states, and no incentive to try to get you an exception. Good luck.
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