Does Insurance Cover a Newborn When Born in the Hospital?

As of 2012, a newborn is covered under the federal Newborns' And Mothers' Health Protection Act of 1996. Most plans have specified times in which you can add or change coverage. The HPA of 1996 simply means a birth overrides those enrollment season deadlines. The protection is extended by the Health Insurance Portability and Accountability Act, also enacted that year. State laws may apply rather than the NAMHPA as long as they meet the same criteria.

Thirty days can go by quickly, especially when you have so many other things to think about with a newborn. So don't wait until the 30-day window is closing to get the baby added to your coverage as a dependent. Contact your health insurance company, or the human resources official at your job, and send in any appropriate papers and payments as soon as possible. Keep a copy of all forms for your records. If you must send the forms by mail, use certified mail. That way, if there is any problem with the receipt, you can prove it was mailed by the due date.

If you enroll the baby within the 30 day window, your insurance provider can't impose any exclusions regarding preexisting conditions. This right is guaranteed under HIPAA and comes with some other bonuses. For example, if you change plans, the insurance carrier can't impose exclusions as long as you don't allow the baby to go without coverage for a "significant" length of time. In insurance-speak, "significant" means a period longer than a minimum of 63 days.

Check with your insurance provider or employee benefits representative to go over your coverage as soon as you find out you're pregnant. Insurance providers aren't required to provide maternity benefits in all health plans. Some women don't find this out until they learn the plan doesn't even cover their prenatal care. You might still be able to enroll the new baby as a dependent within 30 days, but it may not include coverage for the actual birth and subsequent hospital stay.