January 19, 2009,
L.T. asks from Castro Valley, CA on January 13, 2009
Missed the 30 Day Enrollment Period for Insurance for Our Newborn
My son is 2 months old today. He goes in for his 2mo well check on Friday and I just found out he isn't covered on our insurance. This is because during my husband's work deadlines and the holidays, he forgot to add him within 30 days of his birth. HR told my husband that we can't add my son because it's over the 30 days and it's Federal law. I can't find the law. Does anyone know anything about this? I called Aetna and they told me to talk to HR, when I informed her that we had she said that our employer didn't have to let us enroll after 30 days. We either have to get secondary ins. or pay out of pocket. Does anyone know if this law states that the employer "can't" add anyone after 30 days or if it just means they don't have to if they don't want to? Another thing, does anyone know a way around it? According to HR we have to wait until the next enrollment period, which is a year away. I found something online about signing as a "late enrollee" but I don't know if that applies to us since we have the rest of the family signed up. FYI- My husband's employer switched ins. effective Jan. 1. Any ideas or help will be greatly appreciated.
2 moms found this helpful
So What Happened?™
I love this site!!! Every response was helpful! I appreciate all the information and to everyone that responded--- a great big THANK YOU!!!! For anyone else out there in the same situation, it is as the others say "the squeaky wheel gets oiled." I spoke with everyone I could think of. I was even about to write a letter to the CEO of the company but I feared negative consequences for my husband.
I started writing everything that transpired but since I am a detailed person it was getting pretty lengthy. So here is the short of it-- they are adding my son!! I made calls to Aetna,an Aetna broker, the CA Insurance Commissioners office, and the IRS. I also sent e-mails to my husband's boss, the HR reps boss, and mistakenly to the recruiting dept. That mistake was a lifesaver because soon the whole office new about our situation which meant the higher ups found out. Legally, they can stand behind IRS Sec. 125 which states that we only have 30 days BUT here's the catch it all depends on the plan within Sec. 125 and whether they have added or deleted any policies (which they can.) The IRS told me to get a written copy of the company's policies. They have to have it written down as to whether they kept the 30 day period in there. Anyhow, everything soon was out of my hands and if it weren't for the higher ups getting involved and putting pressure on them nothing would have happened. HR would not give us a copy of the policy but just sent an e-mail restating their position and to find other insurance. So now, I have another request. I am so thankful to my husband's boss, his boss, the CFO and the CEO for getting involved otherwise they wouldn't have added him- so how do I say thank you? A separate card to each or a gift basket for all? Or let my husband go thank them?
Thanks again to all of you. All your ideas and support were great!!
E.M. answers from Sacramento on January 14, 2009
My guess is that the law requires them to add up to 30 days after, but not after that, but nothing prohibits them from adding him later than that.
I would go to management if HR is being so impossible to work with. Good luck!
N.C. answers from Sacramento on January 14, 2009
Call the HR department, you can get around it, but it is a lot of paperwork. If the company doesn't let you, keep pushing them. Call everyday etc, they will do it eventually, lot of red tape though.
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M.M. answers from San Francisco on January 14, 2009
Unfortunately, this is a rule governed by Section 125 of the IRS codes and the employer is limited by the regs. Unfortunately, the best plan of action would be to get a personal health plan for the newborn so you do have coverage. Kaiser plans are usually inexpensive if you are willing to work within their system. Good luck to you!
S.B. answers from Redding on January 14, 2009
Congratulations on your new baby and I'm so sorry you are going through this stress on top of everything else right now.
I am an insurance agent on leave after breaking my leg. You can contact me privately and I will give you my e-mail address if you'd like to talk further. I was able to help another family not too long ago. Let me say that I am not currently working and not affiliated with any broker or insurance carrier so I can remain completely objective and there is nothing in it for me.
A couple of things I thought about"
1. Since your husband's employer changed insurance carriers effective Jan 1, HR, if they were doing their job, should have reported the impending birth to the new insurance company (or their broker) in order to get a proper quote and risk adjustment factor based on the number of employees and family sizes.
2. Depending on how the insurance carrier structures "family", since you have 3 kids on the plan already, the premium should not be different. Or minimal.
3. Newborns are automatically covered under the mother's coverage for the first 30 days of life. Sometime within that period, you are supposed to add the newborn as it's own little person, another dependent.
You would be surprised how many times this doesn't happen, for whatever reason, and it's usually a case of someone not knowing what to do.
It takes a little work and finesse on someone's part. But it is possible to get the baby added. I've done it a hundred times.
If you need any help or just want to talk....let me know.
Best of luck to you!
1 mom found this helpful
D.M. answers from San Francisco on January 14, 2009
Sorry to hear that. I work in HR also and the insurance companies actually won't allow us to add someone outside of the 30 day deadline. You can try to ask HR if they can make a special request to the insurance company to retro your son's enrollment for the first of the following month after his date of birth and then back pay for the premiums but this isn't guaranteed by any means. I believe it would have to be approved by a higher level manager and the insurance company.
Otherwise, you would have to get your own private insurance for the baby.
Usually you can add a dependent due to a qualifying life event (birth, marriage, death, adoption, loss of coverage). Loss of coverage is usually when you cover your spouse and they lose their job/insurance then you have 30 days to enroll them onto your insurance. However, I wonder if you could get private insurance for the baby for 1 month and then cancel it and add him onto your husband's insurance due to a loss of coverage.
1 mom found this helpful
E.M. answers from San Francisco on January 14, 2009
I think people are misinterpreting the law. Doesn't it say that they must offer insurance for 30 days after a birth and that they must have open enrollment annually? It doesn't say that CAN'T enroll people at any other time or under any other circumstance. It just sets a minimum.
It would be ridiculous for a federal law to say that people have to stay uninsured for a year if they missed a beaurocratic deadline.
Write a fierce letter and ask them to document their claim that they can't enroll the baby.
K.M. answers from San Francisco on January 14, 2009
Your HR can do it as long as they communicate with the insurance company and are willing to do it. It sounds like they are making excuses...your newborn will add expense to them and this gives them a one year out on that. Like someone else said...keep bugging them. Not sure if your husband's company is large or small, but a large company might be harder to sway. A smaller company normally has a closer relationship with their employees and tries to held in a situation like this...good luck.
G.L. answers from Fresno on January 14, 2009
hmmm if they changed insurance jan 1 isn't that an opportunity to add or change? if you really can't get him added apply for Healthy Families.
D.Z. answers from Yuba City on January 14, 2009
I've never heard of a 'law' that states that, I believe that is bogus. However, this happened with my twins last year. I wrote a letter to the insurance company, apologized for not nowing about the 30 day enrollment period and basically kept hounding them politely until they agreed to add my twins to the policy. It worked. If you cannot, please check out the HEalthy Families program in CA, it is more median income people who cannot afford full insurance for the children, it is very reasonable, I had it for one of mine and it was wonderful.
T.G. answers from Sacramento on January 14, 2009
The insurance change on January 1st was probably because they dropped a plan & added a different one. They usually advise employees of this change during open enrollment, which means they do not have to let you enroll if you missed enrolling for the life changing event. Good luck with the HR battle that the others have suggested. If it is a large company, you will have a tough time getting them to bend the rules for you.
E.G. answers from San Francisco on January 16, 2009
I'm sorry you have to go through this, it must be very stressful not having insurance for your baby. I went through something similar with Kaiser. My son is on his own plan through Kaiser (it was cheaper than what my employer could offer me with Kaiser). But when I went to sign him up, it was last minute and they could not process the paperwork before the first of the month. So, they have a plan that is more expensive, but it does not require any health checks, etc. As soon as they faxed the paperwork, he was insured. I'm not sure if Aetna has a similar "gap" insurance that you could have until you get everything sorted out, or until open enrollment but you might ask them if you have not done so already. I hope this helps. FYI: I don't know how much you pay per child with Aetna, but Kaiser for my son is $198.00 per month with $25.00 co-pay and free wellness visits (regular check-ups), and $10.00 prescriptions.