As my wife and I welcomed our second son into the world a little over a week ago, we were consumed with the joy and excitement of bringing a little one into this world! We were fortunate in that he was very healthy and there were no unexpected health concerns. What about when medical attention is needed immediately after the birth of a child? If the parents have medical insurance coverage, at what point does the newborn become an additional insured entitled to coverage under their insurance? Does it happen at conception, delivery or at some other or later point? After all, being entitled to the benefits of the insurance coverage can mean saving thousands of dollars in out of pocket medical expenses.
Medical policies may automatically cover newborn dependents of the insured. Generally, such coverage does not attach until the moment of birth. Policies may qualify such coverage in a variety of ways as, for example, requiring a waiting period before coverage attaches, or requiring some action on the part of the insured to initiate coverage or continue coverage beyond a stated grace period. Various states have regulations that apply to insurance coverage of newborns. For example, California mandates that insurers provide coverage from birth for an unspecified grace period to allow the insured the opportunity to add the name of the new dependent to the policy. In Texas, insurers are prohibited by statute from issuing combined policies of health and accident insurance which contain restrictions on coverage of newborns in the health but not the accident policy. Such state regulations may be made applicable to only certain species of medical policy, such as group insurance.1
In Florida there is a statute regarding health insurance coverage for newborn children. F.S. 627.641. It generally provides that coverage begins “from the moment of birth” and continues for eighteen (18) months. The Florida statute allows a policy to require the insured to notify the insurer of the birth of a child within a time period, as specified in the policy, of not less than 30 days after the birth. If timely notice is given, the insurer may not charge an additional premium for coverage of the newborn child for the duration of the notice period. If timely notice is not given, the insurer may charge an additional premium from the date of birth. The insurer may not deny coverage for a child due to the failure of the insured to timely notify the insurer of the birth of the child.
So it appears that my boy was automatically covered under my health insurance policy from the amazing moment when he first entered this world. It’s nice to have peace of mind! It’s also nice to know that the law in Florida gives new parents a grace period to notify the insurer of the birth so they don’t have to be consumed with that paperwork while enjoying their new addition to their family.
1 Couch 144:28 Dependents, Generally—Newborns.