NEWSROOM

You know that one of the things we pride ourselves on at Word & Brown is helping our brokers stay up to date on changing rules, regs, and carrier services.

As part of that effort, we’ve recently surveyed our carrier partners on current coverage for newborn services.Below is information – organized by carrier – on how each treats newborn services.

If you have questions concerning any of this information, contact your Word & Brown rep.

What is the effective date of coverage for a newborn, and how are premiums requested?

The newborn will be covered starting from the birth date, and the group has 31 days to request this from Aetna.  Aetna does not pro rate so premiums will start the 1st of the next policy month unless the date of birth is the 1st of the month.

Is there an additional cost for covering the newborn during the first 30 days?

The member’s premium will be charged as EE + Child(ren) or EE + Family.

Does this apply to both the mother and the father?

Yes, this applies to both the mother and father, and the billing process is the same for both Small Group and Large Group.
 

 

What is the effective date of coverage for a newborn, and how are premiums requested?

Coverage for newborns becomes effective on the date of birth. Premiums are prorated according to the birth date. For instance, if a newborn is born on the 15th of the month, Anthem will assess premium for 15 days of coverage at the prorated rate.

Is there an additional cost for covering the newborn during the first 30 days?

Newborns receive coverage under the subscriber’s plan for the initial 31 days following birth.  No extra premium is charged during the first 31 days if the newborn is never added as a dependent.

Does this apply to both the mother and the father?

Coverage may be provided under the mother’s plan, the father’s plan, or both plans.

What is the effective date of coverage for a newborn, and how are premiums requested?

The effective date for newborn enrollment is the first day of the month following the birth. This policy ensures that claims are automatically covered for the first 30 days without incurring unnecessary premium charges. If a member wishes to have coverage start on the date of birth, Anthem can accommodate that request; however, premiums will be billed starting from the date of birth.

Is there an additional cost for covering the newborn during the first 30 days?

No.

Does this apply to both the mother and the father?

Yes.

What is the effective date of coverage for a newborn, and how are premiums requested?

Coverage for the dependent is effective as of the date of birth. Premiums are prorated based on the number of days the dependent is enrolled during the initial month of coverage.

Is there an additional cost for covering the newborn during the first 30 days?

Blue Shield of California does not issue a bill for a newborn until the newborn is formally added to the insurance plan. Once the newborn is billed, the deductible (DED) and out-of-pocket maximum (OOPM) may be adjusted to a family tier, depending on the group’s billing structure.  To add the baby retroactively as of the date of birth, the employee must complete and submit a change request form.

Does this apply to both the mother and the father?

If the newborn is not added to the plan, the billing will stay the same.

What is the effective date of coverage for a newborn, and how are premiums requested?

If a newborn's date of birth (DOB) is on or before the 15th of the month, dependent coverage will be retroactive to the 1st of that month, and a full month's premium will be billed. If the DOB is after the 15th of the month, coverage will begin on the 1st of the following month.

Is there an additional cost for covering the newborn during the first 30 days?

No.

Does this apply to both the mother and the father?

Yes.

What is the effective date of coverage for a newborn, and how are premiums requested?

Health Net will enroll newborns as of the date of birth, and the 1st month will be prorated.

Is there an additional cost for covering the newborn during the first 30 days?

Health Net could prorate the premium for the newborn based on the date of birth.

Does this apply to both the mother and the father?

Yes.

What is the effective date of coverage for a newborn, and how are premiums requested?

All plans provide coverage for services the newborn receives during the newborn eligibility period under the parent’s or guardian’s health plan.

Is there an additional cost for covering the newborn during the first 30 days?

No, services that fall under a supplemental benefit are covered if that supplemental benefit is included in the parent’s or guardian’s plan.

Does this apply to both the mother and the father?

Yes, during the newborn eligibility period, the applicable cost share is the parent’s or guardian’s cost share for any services the newborn receives.

What is the effective date of coverage for a newborn, and how are premiums requested?

The effective date will be the newborn’s date of birth. Premiums will automatically generate after the newborn is added under the subscriber, beginning the month following enrollment.

Is there an additional cost for covering the newborn during the first 30 days?

The premium is waived for the first 30 days.

Does this apply to both the mother and the father?

It applies to the enrolling subscriber, regardless of whether the mother or father is enrolling.

What is the effective date of coverage for a newborn, and how are premiums requested?

Newborns may be enrolled either as of their Date of Birth (DOB) or as of the First of the Month Following (FOMF) their date of birth. Premium charges depend on the effective date of enrollment, as outlined below:

When a newborn is enrolled effective on their date of birth, premiums are determined by the baby's actual birthdate:

• If the baby is born between the 1st and the 15th of the month: Premiums begin on the 1st of the month following the date of birth.
• If the baby is born on or after the 16th of the month: Premiums begin on the 1st of the month following the second full month after birth.

When enrolling the newborn using the FOMF effective date, premium charges begin based on the assigned effective date, not the actual date of birth."
 

Is there an additional cost for covering the newborn during the first 30 days?

No.

Does this apply to both the mother and the father?

Yes.

What is the effective date of coverage for a newborn, and how are premiums requested?

Coverage for a newborn begins at the moment of birth. However, if the newborn is not enrolled within 60 days, they will only be covered for the first 30 days (including the date of birth) under the mother’s plan.

The newborn may be enrolled with an effective date of either:

• The date of birth, or
• The first day of the month following the birth.

Premiums vary by plan. For Small Group (SG) plans, rates are age-banded."

Is there an additional cost for covering the newborn during the first 30 days?

No.

Does this apply to both the mother and the father?

Yes, for the first 30 days, the newborn is covered under the mother’s plan. After 30 days, charges will apply once the baby is enrolled.

If the newborn will be covered under the father’s plan, and enrollment is effective on the date of birth, charges start from that date. Charges can also begin on the first day of the effective month, depending on the enrollment choice.

What is the effective date of coverage for a newborn, and how are premiums requested?

Coverage for newborns begins on the date of birth.

Premiums vary based on whether the group uses composite rates or age-banded rates.

Composite Rates:

Premiums are determined by the family coverage tier—Employee, Couple, Parent & Child(ren), or Family—regardless of how many children are enrolled.

• When adding a newborn, no premium increase applies if another child is already covered under the plan.
• If the newborn is the first and only child, the premium is prorated after the first 31 days of coverage.

Age Banded Rates:

Premiums are based on the age of each individual enrolled and are prorated after the first 31 days.

• A maximum number of children may be billed; for example, if five children are enrolled, the plan may only charge premiums for three, depending on the carrier’s guidelines.

UnitedHealthcare policy allows the group at least 60 days to provide official notification of a newborn’s enrollment (also referred to as positive enrollment).

An SSN is not required at the time of adding a newborn. It can be submitted once it has been issued.

Is there an additional cost for covering the newborn during the first 30 days?

There is no premium increase during the first 31 days of a newborn’s coverage.

Does this apply to both the mother and the father?

Yes.
 

 

What is the effective date of coverage for a newborn, and how are premiums requested?

Coverage for a newborn begins on the date of birth. If the newborn is born between the 1st and 16th of the month, the full month’s premium is billed. If the newborn is born after the 16th, the first month’s premium is not billed.

Is there an additional cost for covering the newborn during the first 30 days?

The premium for the first month of coverage is written off.

Does this apply to both the mother and the father?

Yes.