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U.S. Department of Labor Seal U.S. Department of Labor

Health Benefits Advisor

Childbirth - Group Health Plan through My Job

If certain conditions are met, you, your newborn and your spouse may have the opportunity for special enrollment as well as other enrollment opportunities in a group health plan offered by your employer or employee organization, or both, regardless of whether you are presently enrolled in the plan or when the plan otherwise permits enrollment.

Qualifications for Special Enrollment

The following individuals may qualify for special enrollment in your group health plan if your plan provides coverage for dependents:

  1. You, if you are not already enrolled in the plan and are otherwise eligible;
  2. Your newborn, if your plan covers children and you are already enrolled in the plan or you enroll with your newborn; and
  3. Your spouse, if your plan covers spouses and you are already enrolled in the plan or you enroll with your spouse.

Time Frame for Special Enrollment

In order to special enroll in your group health plan, you must request the enrollment within 30 days of the newborn's date of birth. If special enrollment is properly requested, the plan must make the enrollment effective on the child's birth date.

Additional Enrollment Rights

In addition to the special enrollment rights just described, you and your family members may have other rights to enroll in your group health plan. Additional rights to enroll may exist under the terms of your group health plan or under state law.

To find out more about enrollment rights in your group health plan:

  1. Read the notice of special enrollment rules that the plan was required to give you when you were offered the opportunity to enroll in the plan;
  2. Review the SPD (summary plan description) of your plan for information about enrollment rights; and
  3. Contact your state insurance department to find out if state law gives you or other family members additional enrollment rights.

How to Choose Among Health Coverage Options

Depending on your circumstances, you and your family members may have health coverage options available besides your group health plan. Before making any decisions, you should carefully consider information on your plan, any group health plan offered through your spouse's job, and other coverages for which you and your family members may qualify.

In choosing among the options available to you, you should review the SPD for each available group health plan to determine which plan best meets your needs. You should also review and compare the information on the other coverages for which you are eligible. In making your decision, you may want to consider such things as:

  1. Any waiting period (or affiliation period) imposed under the plans;
  2. Types of benefits offered (Is dependent coverage available? Do the benefits cover your family's medical needs?);
  3. Cost of coverage (premiums, co-payments and deductibles for prescription drugs and doctor visits);
  4. Limitations on coverage; and
  5. Any exclusions from coverage (treatments, procedures, conditions or prescription drugs).

To find out about other kinds of health coverage for which you and your family members may qualify, return to the Childbirth/Adoption Page and select another option.

UNITED STATES
DEPARTMENT OF LABOR