Automatic Coverage Gap for Newborns?

[Norwayguy]

Welcome to parenthood and about time they leave dependence on their parents.

I'm sorry I can't be the only person thinking we just ended 6 months of enrollment for a plan that the mother could have purchased....I am assuming the actual birth did not come out of left field. I can not believe that no one during the 10 months of pregnancy thought he what happens when the baby is born?

 

[Yagents]

Apply immediately, and SEP will give baby eff date of may 1st under federal exchange

 

[dgoldenz]

Apply immediately, and SEP will give baby eff date of may 1st under federal exchange

June 1 according to the federal marketplace when I called earlier....and they are in DC which requires everybody apply through the state exchange whether subsidized or not.

 

[unic.consulting]

June 1 according to the federal marketplace when I called earlier....and they are in DC which requires everybody apply through the state exchange whether subsidized or not.

The only thing I can think of then is to talk to the underwriters at the insurance company and see what they can do.

 

[houcoogster]

May 1st...................don't listen to them they don't know.

 

[RayNY]

I hate to disagree with everyone, but the plan is effective on the date of birth when the qualifying event is a birth.

Everyone's favorite section of ACA, 45 CFR 155.420
"(2) Special effective dates.
(i) In the case of birth, adoption or placement for adoption, the Exchange must ensure that coverage is effective on the date of birth, adoption, or placement for adoption, but advance payments of the premium tax credit and cost-sharing reductions, if applicable, are not effective until the first day of the following month, unless the birth, adoption, or placement for adoption occurs on the first day of the month; and..."

Bolded for emphasis, I think that passage is very clear on what the effective date will be. If you want to call and do the right thing for the client and get the child coverage from day 1, at least you can quote the law for support.

 

[DS4]

the Exchange must ensure that coverage is effective on the date of birth

......................................

 

[dgoldenz]

I hate to disagree with everyone, but the plan is effective on the date of birth when the qualifying event is a birth.

Everyone's favorite section of ACA, 45 CFR 155.420
"(2) Special effective dates.
(i) In the case of birth, adoption or placement for adoption, the Exchange must ensure that coverage is effective on the date of birth, adoption, or placement for adoption, but advance payments of the premium tax credit and cost-sharing reductions, if applicable, are not effective until the first day of the following month, unless the birth, adoption, or placement for adoption occurs on the first day of the month; and..."

Bolded for emphasis, I think that passage is very clear on what the effective date will be. If you want to call and do the right thing for the client and get the child coverage from day 1, at least you can quote the law for support.

Thanks. My conversation went something like this:

Me: "So can you show me where in writing you found the information that you just told me? That way I can show it to my client instead of taking your word for it"

HC.gov rep: "No sir, it's not anywhere on healthcare.gov, but I did ask my supervisor"

Me: *Repeatedly bashes head against the wall*



I'll still bet a nickel that the exchange and insurance companies with their powers combined will screw this up.

 

[RayNY]

They NEVER provide ANYTHING in writing. At least here in NY, you have to EMAIL a "council", that says they'll reply in a few weeks, but just plain don't.

Call back until you get the answer you want...Insist you're correct, cite the exact section of law verbatim, and insist the carrier reps have told you this is the case.

There's a lot of poorly informed, barely trained, inexperienced, seasonal, public employees on the other side. It may take a few tries to get a competent human on the line.

 

[bobson]

So what happens if the baby was a premie? 2 weeks of that care could create quite the bill.