Had a new situation come up today - 25 year old whose daughter was born two weeks ago. He is currently covered under his parents' group health insurance, so they can't add the baby to that policy and wants to buy individual coverage. I was told by both the federal and DC marketplaces that the coverage would not be effective until June 1 rather than being retroactive to the date of birth. The DC marketplace told me the baby should be covered under the mother's policy for one month from the date of birth (which I'm pretty sure is incorrect), but even in that scenario if a baby is born after the 15th of the month, there will always be a coverage gap. Anyone else come across this problem yet?
Automatic Coverage Gap for Newborns?
- Thread starter dgoldenz
- Start date
I am a group guy, not an Individual, so bear with my limited response.
You should read the plan documents to find out who is defined as an eligible dependent. Highly unlikley, but possible, that the grandchild is an eligible dependent.
Group plans have a 30-day window for newborns, meaning that the employee has 30 days to notify the plan that a dependent is being enrolled. If the employee exceeds the 30-day limit, the dependent could be turned down and must wait till the next OE period.
Hope this helps.
You should read the plan documents to find out who is defined as an eligible dependent. Highly unlikley, but possible, that the grandchild is an eligible dependent.
Group plans have a 30-day window for newborns, meaning that the employee has 30 days to notify the plan that a dependent is being enrolled. If the employee exceeds the 30-day limit, the dependent could be turned down and must wait till the next OE period.
Hope this helps.
- Thread starter
- #3
I have never seen a group policy that will accept a dependent of a dependent. This particular person already checked and was told the child cannot be enrolled under his parents' policy. That is why I am skeptical that there is a "free" 30 days of coverage for the newborn under the mother's policy since she is in the same boat, which would leave the newborn with a 47 day coverage gap since birth.
- 4,707
- 599
Who is the mother covered by? I wouldn't think she would be covered by her in-laws.
- 4,707
The more I think about it, I believe the baby would be covered for 30 days under the mother, even with the mother being a dependent under her mothers policy.
Still probably going to be some gap in coverage.
Still probably going to be some gap in coverage.
- Thread starter
- #7
Mother is also under her parents' group policy.
- 599
Then that group policy should cover for the first 30 days. As for the 15 day gap, I don't know what can be done about that currently. Off-exchange might be the best option.
- 4,707
Is the father in the picture? Maybe the father has IFP or group coverage the baby could be added to.
- Thread starter
- #10
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