Newborn baby lying in a crib with a soft blanket, representing health coverage and enrollment rules under HIPAA for newborns.

Health Coverage For Newborns | Q & A

Q. I have heard references to newborns being “automatically covered” by the mother’s health plan for 30 days after the date of birth, but I can’t find a source for that. The closest I can find is the HIPAA special enrollment rules allowing coverage retroactive to date of birth, but the employee has to actually enroll the child. Can you clarify the rules?

A. The “automatically enrolled” references are misleading. An employee must affirmatively elect to have a newborn covered. HIPAA gives an employee a special enrollment window in which to ask for coverage, and the law provides that if you elect coverage for the newborn within 30 days, coverage will automatically go back to the date of birth. However, the employee must affirmatively enroll the newborn. If the employee does not enroll the newborn in a timely manner, there is no coverage for the newborn at all (including the first 30 days of the newborn’s life).

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