Tricky insurance scenario with expectant twins with likely complications and extended NICU stay. Expected due date in early September or late August. Looking for insight on medical insurance choices:
Father (myself) currently has employee+children coverage with an Anthem HDHP (deductible=$6,000, MOOP=$12,700), but the plan year is from 10/1-9/31 (potential for covering multiple plan years during NICU stay). Open enrollment is in August. A Gold level plan (deductible=$1,000, MOOP=$8,000) is available at reasonable cost (EE+children = $168/biweekly), and switching to this on the DOB seems like a good plan, but not if a NICU stay covers 2 plan years, resetting deductible and MOOP.
Mother has individual employee coverage with a Cigna HRA plan (deductible=$1,750, MOOP=$3,000), with a calendar plan year. Individual MOOP has already been met with prenatal care costs. An Enhanced/Gold plan (deductible=$1,000, MOOP=$8,000) is available for EE+children at higher cost ($356/biweekly). Mother expects to switch to part-time work in December/January, which would trigger loss of insurance and another qualifying life event.
Mother's DOB is later in year than Father's DOB, meaning that Father's insurance would be primary should the birthday rule apply in determining primary insurance for newborns. No other medical conditions in family. all located in Ohio.
Questions:
1. Does the birthday rule apply in this scenario for determining newborn primary insurance?
2. How long will newborns be covered under mother's individual plan as primary if father has a plan that already includes children?
3. If multiple plan years are expected to be covered by a NICU stay, does it make sense to pay the higher premium for the calendar plan year insurance (that will likely only last through December/January)?
Father (myself) currently has employee+children coverage with an Anthem HDHP (deductible=$6,000, MOOP=$12,700), but the plan year is from 10/1-9/31 (potential for covering multiple plan years during NICU stay). Open enrollment is in August. A Gold level plan (deductible=$1,000, MOOP=$8,000) is available at reasonable cost (EE+children = $168/biweekly), and switching to this on the DOB seems like a good plan, but not if a NICU stay covers 2 plan years, resetting deductible and MOOP.
Mother has individual employee coverage with a Cigna HRA plan (deductible=$1,750, MOOP=$3,000), with a calendar plan year. Individual MOOP has already been met with prenatal care costs. An Enhanced/Gold plan (deductible=$1,000, MOOP=$8,000) is available for EE+children at higher cost ($356/biweekly). Mother expects to switch to part-time work in December/January, which would trigger loss of insurance and another qualifying life event.
Mother's DOB is later in year than Father's DOB, meaning that Father's insurance would be primary should the birthday rule apply in determining primary insurance for newborns. No other medical conditions in family. all located in Ohio.
Questions:
1. Does the birthday rule apply in this scenario for determining newborn primary insurance?
2. How long will newborns be covered under mother's individual plan as primary if father has a plan that already includes children?
3. If multiple plan years are expected to be covered by a NICU stay, does it make sense to pay the higher premium for the calendar plan year insurance (that will likely only last through December/January)?
