- Health Benefits Advisor
Depending on the circumstances, after you have a new baby, you and your family members may have the right to enroll in a group health plan offered through your job or your spouse's job, even if neither you nor your spouse is presently enrolled in the plan. Group health plans that already cover you or your spouse often automatically cover your newborn, provided you notify the plan. You should read your plan's SPD (summary plan description) to find out how and when to notify the plan of your new baby. In addition, the law limits pre-existing condition exclusions for pregnant women and newborns. More information is provided in the pre-existing condition exclusion regulation.
Important Note: Pregnant women and newborns may be entitled to coverage for minimum length of hospital stays in connection with childbirth. More information is provided in the interim regulation issued under the Newborns' and Mothers' Health Protection Act.
Qualified Medical Child Support Orders (QMCSO). You may want to consider whether a QMCSO would be a useful tool for obtaining group health coverage for your newborn. A QMCSO requires the enrollment of a child of a participant in a group health plan. In general, a QMCSO is a judgment, decree, order or notice issued by a State court or administrative agency that provides for the support or health coverage of a child of a participant, and that meets certain requirements under ERISA. More information is provided in the final QMCSO regulation.
Before deciding which coverage best meets your needs, you may want to consider the different kinds of coverage available to you and your family.
Which type of coverage would you like to consider?
- Enrollment in a group health plan offered through my job
- Enrollment in a group health plan offered through my spouse's job
- Medicaid - Government-sponsored health insurance program for low-income individuals and individuals with special needs and their families.
- State Children's Health Insurance Program (SCHIP) - Government-sponsored health insurance program for children of qualified families. Each state determines the income level for families to qualify. In most cases, eligible families can have income levels well above the national poverty level.
- Medicare - A Federally funded health benefits program for people aged 65 and over, and for certain people under 65 who are disabled or have permanent kidney failure.
- Other Health Coverage - This category includes coverage from another source such as individually purchased health coverage, coverage through a club or association or any other source not listed above.