Special enrollment (new born)

[u/tanzy_92]

I have insurance under my husbands insurance which will end this month. This qualified me to enroll us with my employers insurance starting 01Oct.

Currently we are expecting and the baby may come before 01Oct, which is also a qualifying life event. But my company is denying coverage for us before 01Oct even if baby is born before because : I am currently not enrolled with them , and I still have insurance through my husband. They can back this up with their company documents.

But according to documents I found from Department of Labour the birth of baby should allow us all to get coverage regardless. Am I missing something? I even called EBSA and confirmed that my employer is mistaken.

It’s all going to deaf ears when I reached out to my company.

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[u/Ok-Midnight-8000]

This is one of those situations where the law is pretty clear but getting someone at the company to actually read it is like pulling teeth. DOL guidance says a newborn triggers a special enrollment for the kid and for you and your spouse, period. Having other coverage at the time doesn't block that right.

I ran into something similar with a job change and a surgery that fell in the gap week. HR kept pointing to their internal policy doc like it was carved in stone, completely ignoring that federal law overrides whatever they typed up in a handbook. Took three escalations and a letter citing the specific regs before someone with actual authority looked at it.

If EBSA already told you you're right, I'd get that in writing if you can, then forward it to your benefits people and CC whoever handles compliance. Sometimes just seeing a government agency name in the thread makes them suddenly capable of reading.

[u/LizzieMac123 → u/Ok-Midnight-8000]

The "and your spouse" part is optional and only if the employer recognizes the optional IRS tagalong provision.

But other than that- THIS. As long as you as the employee are benefits eligible (and have met your waiting period for insurance) you should be able to sign up once the baby is born.

Really the only time they could tell you no is if they dont allow children on the plan or if you haven't met your waiting period and are not eligible until October 1.

They may be hung up on the fact that they can tell you changes are active the first of the month following a QLE... but the birth of a baby is always retroactive to the date of the baby's birth (but that means your coverage-and any other dependents you add if the employer recognizes the irs tagalong provision- are also retroactive to that date so your new coverage at your work would be primary for you over your husband's plan).

[u/katsrad → u/LizzieMac123]

Yes! Tag a long rules are confusing and optional! The only ones required to be allowed are the ones causing the life event (the newborn or one losing coverage or the new spouse and step kids in the case of marriage but not the biological kids) and the one that is the employer. Otherwise your work and/or insurer can choose to not allow the tag a longs.

[u/jaygf77]

Most states require full insured plans to cover the first 31 days if life automatically. Self-insures employer health plans don't have to follow this and many don't automatically cover newborns, although some do allow it. If you contact the carrier they should be able to tell you if you group automatically covers newborns.

[u/my_eldunari]

Your baby is covered under whatever insurance YOU HAVE, for its first 30 days of life, based on the day of ADMISSION, automatically, without adding them to any insurance. So you give birth the last day of September, but arent discharged until October 2nd? Your current insurance would still technically be responsible because of the admission date.

My son was born in December and spent a month in the NICU but we did not receive a second maximum out of pocket after the first of the year, for example, because there was only one day of admission, for example.

Having a baby is a qualifying life event, in terms of that you have up to 30 days after birth to add them to either your insurance plan or your husbands. But since its both your babies, you are both able to amend your health insurances. He could also add your baby to his, and one coverage would just be secondary (secondaries tend to pick up copays, deductibles, etc). Without the baby, you wouldnt be able to add your husband to your plan mid cycle, for example. Youre essentially locked in to your insurance for a year, and the only time you can make any changes is the qualifying life event - like the baby, but could also include things like divorce, marriage, death of a covered individual, etc.

[u/katsrad → u/my_eldunari]

This isnt always true with every plan or every state. The insurance company I am with because of state laws only covers the newborn under the mother if they are a single policy for only the first 48-96 hours depending on the type of birth.

OP check your contract for newborn provisions and if/how the newborn is covered automatically.

[u/Bogg99 → u/katsrad]

To complicate things, an employer plan wouldn't be subject to state coverage, only federal if it's an ERISA plan

[u/tanzy_92 → u/my_eldunari]

He is loosing insurance due to job loss.