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elaws - employment laws assistance for workers and small businesses

- Health Benefits Advisor

Childbirth

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?