36 answers

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

What can I do next?

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!!

Featured Answers

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!

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.

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!

More Answers

Dear L.,
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

Hi L.,

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.

Good luck!

1 mom found this helpful

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.

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.

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.

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.
Happy blessings!
D.

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.

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.

L.,

I have worked in an HR department. Yes, it is the law. You can drop insurance anytime, but the only times you can sign yourself or a family member up are: open enrollment (the once a year thing), within 30 days of starting a new job, or within 30 days of a life changing event like the birth or adoption of a child, marriage, divorce, or your spouse loosing insurance coverage because of loosing a job. I don't know of a legal way around it but often in these types of situations I saw the squeaky wheel get the grease if you know what I mean ;) Good Luck

They can add you, but wont and dont have to. Been through this once for the entire family and once with a newborn.

The insurance companies will do whatever and only what HR tells them too.

Look into Healthy Families for the year

Your employeer can add and delete you at any time most of the time.....the insurance provider will take your money whenever they are offered it.
It's the employees companies policy most of the time. Does your husband report to anyone? Higher managment? the CEO? My recomendation would be to get a meeting with a higher up, and see if they would go to HR for you as your advocate. Tehre are way too many bills in that first year.

If they won't budge, every baby in California is covered under different programs, I would call the state to see what you qualify for, or try Kaiser, I know they have some cheaper plans for the year.

I'm really sorry this happened, I know how stressful bringing a new baby home is and this is the last thing you want to deal with.

Yes, the insurance company can add the baby, all you need is to show the birth certificate. Your husband's HR person does not seem to want to do the work and submit the paperwork. Ask her to at least ask the insurance company. They will add the baby. I work in teh insurance field trust me it happens all the time. All you have to do is ask. HR does not seem to want to help.

Hi. Congratulations on the addition to your family. I had some suggestions in case you can't add him on. You can usually get his shots free at the health dept. or they will have a list of where you can go. You can also probably take him to these same places for his well-baby check ups. You might be able to sign him up for Healthy Families, which is just a few dollars a month $6 or so. You have 4 kids so don't rule it out you might qualify you never know. Because they want kids to be covered under some sort of insurance, so that alone (lack of insurance) may qualify him. I don't know where you live but they have a pretty decent list of doctors to choose from. Last if he doesn't qualify for that, when he gets sick you can just pay out of pocket. It might not be as much as you think. Talk to the billing dept. at your doctor's office, they might work with you. Ours charges $55 for a visit if you pay right then and $70 if you want to be billed. And prescriptions- call around before you get it filled. You do not have to be a member of Costco to use their pharmacy and they have very competitive prices. Normally the locally owned pharmacies have higher prices because they just cannot compete with the chains. So I would call places like Wal-mart, Costco, Rite Aid & Walgreens. HTH. Good luck!

I'm echoing a lot of what other moms have said but just wanted to offer support. I handle all the benefits here and technically it is the "law" that you have to add your new baby within 30 days of the birth but I have always been able to work around that. Basically, I would tell the insurance company that I had submitted the paperwork and blame them for losing it or not processing it. Clearly the HR person at your hubby's company isn't willing to be this creative. Also, we just changed to a new plan effective January 1st and it is open enrollment for everyone here until January 31st. This should be the same for your husband's company. You just need to get in HR's face and demand some accomodation! Go up the food chain if need be. Good luck to you....it can be done!

I read all of the responses you have gotten and you are probably best to contact Healthy Families to get him added. Both of our children have Blue Cross through Healthy Families and it's the best insurance coverage. They also have dental and vision and we only pay $36.00 per month. The coverage is better then what my husbands employer offered. Go to www.healthyfamilies.ca.gov. It also states on their website that there is "no waiting period for new enrollments." Good luck!

I do the enrollment for our small company, and let me assure you the insurance company wants your money. It's the HR that's being difficult. Go to a higher up and nicely make your point. They loose no money since they just switched and technically the enrollment period is open for the whole company. Push. It's worth it.

This happened to me with my second child. I don't know the laws, but I can tell you how we got around it. We had to have the HR guy at my husband's company basically lie and tell the Insurance Co that he faxed the form in time and he didn't understand why they didn't receive it. They let him fax the form and they added my daughter retroactively so everything was covered. If you make nice with the HR person and don't have any qualms with the ethics of my approach, you may have a chance that way.

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.

L.,

I'm so sorry to hear that you missed the 30 day period! The other person who responded is correct. It is the law. But...I would write a letter to the company and ask them if there is anything they can do to help you resolve the situation. Or contact the insurance company directly and ask what they can do for you. Maybe there is a loophole that you don't know about yet. It doesn't hurt to try. Good luck to you!

M.

This is just the worst rule I have ever heard of. Like you don't have enough to do with a new baby! Anyway, my sister-in-law also missed the deadline but her problem came from the insurance stating "the 30 day rule." After several phone calls to the insurance co. and demanding to see in print the rule (which they didn't have in the paperwork she was given) the insurance co. did cover the baby. I am the HR person in a company and we have no such rule or law. I recommend you go back to HR and talk to a supervisor. Ask to see the Federal law in print. Let them know you spoke to your insurance agency and they will cover your baby if they put the paperwork through. I would push it and keep notes of everything you do including dates, names of who you spoke with and outcomes. If they not cover your baby, you will be responsible for the entire cost of the birth!

Good luck!

K. N

I feel for you! The same thing happened to me. I the idea that I had 90 days, not 30. And to top it off, because I didn't get her signed up in time, they wouldn't pay for any of her appointments that were within the 30 days even. So she had two appointments that I had to pay for out of pocket. Lucky for me my open enrollment was only 4 months after she was born, so we got her added at that time. Sorry I don't have any advice, but I wanted you to know you weren't alone!

If your husband switched insurance as of January 1, you should have 30 days after that day to enroll family members. I would look into this more and really push on HR to get your baby enrolled.

I don't know if this would help, but a call to the state insurance commissioner might give you some answers that haven't been mentioned.

I also would recommend that you look into the state insurance programs for children. Those are supposed to cover people in sticky situations as I understand it.

Hi L.,
This happened to my husband after the birth of our second son in 2008 Who came 5.5 weeks early and he almost missed the birth as he was on business in LA for work and i was unable to find him during my labor. He made it thankfully, Since he sounds like your husband with so much going on my husband got side tracked also with closing business and forgot to add our son after the 30 day grace period. Im use to be an HR manager and your husband's HR manager can write a letter to have your baby added. My husband had to write it as his HR manager is "lazy" is what this boils down too and is unable to do this or wants to. They just don't want the extra work. My son was added after 2 letters and the insurance company said to submit any bills that we had out of pocket during the time he was not covered. I would have your husband work his HR manager and draft a professional letter as to why he forgot to add him and submit it to the HR manager insisting they do this. That is what they are there for, for the employees. This can be done as I have written these letters for employees for previous california companies and have had to deal with it myself. Use any information in the letter if you can. My son was in NICU(he is very healthy) as he was a preemie and husband was on business for work,(making them money) very stressful time. The other point we used was when my first son was born we didn't add him as he was just added automatically and since then that ins company was bought out by another ins since having my second son 2 years later. My husband just figured it was also fine as that is what we did before and there were no issues.

SAHM/Zombie 39 with a super funny active 3yr son and a 6month old son who is full of smiles and bubbles. I love being a full time mother.

Hi there,

I don't think it is the law. I work for university of california and I was told that if we missed the deadline to tell them because while they wouldn't be happy they don't want us not to be covered and they are able to offer limited coverage after the 30 days. That makes me think it is harder for the employer to do and ultimately not as good coverage for you but better than nothing.

Good luck!
C.

This HR person doesn't sound like they want to help. Go and ask again, but be sure to be polite, and say that you know you missed the enrollment period, but is there ANYthing they can do for you. Apologize for making extra work. Try to get them on your side. Ask if they can help you solve the problem.

If this doesn't work, I suggest going over their head, talking to your husband's boss, or anyone else with more decision making power. It may be that the HR person's hands are tied and they need a higher ranking person to say it is ok. This is not a legal issue, but a company policy issue. And there are always ways around these things.

If they can't help you, ask for the contact info for the agent who handles the company account and speak to him directly. He may be able to make a deal for you where you pay them directly. Insurance for babies can be very inexpensive.

There are a lot of ways around this problem.

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!

I am really sorry to hear about this. Since you have 6 in the family you may qualify for California Healthy Families. It is around 15 dollars a months for full coverage health care. The application process is not that hard.
http://www.healthyfamilies.ca.gov

Hi L.,

I forgot to add my son to my insurance and did not realize until after the 30 days. It was no big deal, but I was responsible for the a few doctors visits cost and my insurance added my son. Just call your husbands company and tell them you had a lot going on ( 4 kids under 6) and forgot. The company is aware and does covers the hospital cost of a new born. This should not be a big deal for the company. Good luck!

Usually group insurance coverage has an open enrollment period once a year... you might ask HR when that period is. Nothing to add beyond what has already been advised! Good luck!

L., I work in HR at my job. I am not positive if we "can't" add anyone after the 30 days. But I do know that we "do not" add anyone. There are no exceptions allowed. This has been true at several jobs. The other option would be to wait until open enrollment, which is usually around October, which takes effect the next January. You may want to look into a secondary insurance, just until next year.

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!

Try requesting to add the baby effective January 1 with the 2009 open enrollment. Since we're still in January, the insurance company may allow it, and then it's up to your HR department. The 30 day rule for life status changes (birth, death, adoption etc) is enforced by the insurance company and it's usually in the group plan documents / contract.

I'm in HR and I believe that this can be done under the open enrollment exception for 1/1/09; it's just up to the HR department to make it happen for you.

I work in labor law and, regrettably, that's true. You have 30 days from a "life event" to change enrollment status. You'll now have to wait until open enrollment comes around again. Sorry.

L. ~ I am in HR and have been for the past 10 years! and usually u can get around these problems if you want to. Sounds like they just don't want to help you out. They do not HAVE to let you enroll him if you miss the 30 day window, but I have NEVER done that to one of our employees. In fact, I go out of my way to do what I can to get them on there. NOW HERE IS A VERY BRIGHT SIDE TO THIS STORY.....you said that they switched insurance effective Jan. 1? That means that it is OPEN ENROLLMENT and you should have 30 days to add on. I would really press this issue, and go above whoever this HR person is, and speak with her manager or whoever and just keep going up the chain. Sounds pretty ridiculous to me that they are doing this. Was the office at your husbands work closed for a period of time during the holidays when this should have been turned in? If it was I would use that to my advantage also! I hope that you don't just take her word for it, and that you keep pressing the issue. Good Luck!

All great advise, but Janine has a point, and it was what jumped out as me, as well. If the employer changed insurances, you should have 30 days from the first date of the new coverage. I agree that you should press the issue!!! Good luck!

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