Policies for Newborn Coverage – Updated 2013

Adding a newborn to coverage:

• When one or more eligible dependents are currently covered, the newborn must be added to the same coverage, unless there is proof of other group coverage. Proof for a current employee member is kept on file with the Coordinator. Proof for a retired member is sent to EGID.
• A member has 30 days from the date of birth to enroll a newborn in coverage. Premiums must be paid for the full month of the child's birth.
• Newborns must be added the first of the month of the child's birth by filling out an Insurance Change Form.
• A member may 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 premium. Coverage is not retroactive to the month of birth. After 30 days, a retired member cannot add a newborn to the coverage at any future time.
• Newborn coverage is subject to the annual deductible and plan limitations.
• When a newborn is added to coverage, all other eligible dependents must be enrolled in coverage if they are not already enrolled. A member can waive health and/or dental coverage for their spouse.
• The newborn's Social Security number is not required at the time of initial enrollment, but must be provided when received from the Social Security Administration.

Accepting the Newborn Limited Benefit but NOT adding a newborn to coverage:

• There is no additional premium for the Newborn Limited Benefit. 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 only applies if the mother or father of the newborn is covered under health.

Plan Details:

• CommunityCare and GlobalHealth – A newborn is covered for 31 days without an additional premium.
• HealthChoice Newborn Limited Benefit –
  1. A newborn has limited coverage for a routine birth only.
  2. There are no benefits for services in addition to the routine hospital stay if the newborn is not enrolled and premiums are not paid for the month of the birth. 
  3. The member is responsible for any charges over and above the routine limited newborn
     benefit payment regardless of the facility's Network or non-Network status. A separate
     calendar year deductible and coinsurance is applied.

Declining the Newborn Limited Benefit:
(Not recommended)

A Newborn Benefit Waiver must be completed to exclude a newborn from the Newborn Limited Benefit.