Newborn & Mothers Protection


Health Insurance Coverage for Mothers and Newborn Infants

Hospital Stays

According to the Newborns’ and Mothers’ Health Protection Act of 1996, protections for recently born children and their insured parents are offered during the labor and delivery process. This law allows the mother and child entitlement to a 48-hour hospital stay after childbirth for natural births, and 96-hour stays for cesarean sections. This applies to parents with any kind of creditable health insurance coverage. If the mother’s health plan allows for a longer stay due to maternity benefits, this is certainly permitted. Pre-authorization is not required in order for the hospital stay to be covered, though the mother may be asked to notify their insurer of the pregnancy and childbirth plans and dates.

If there is any reason the mother and child feel comfortable being discharged earlier than 48 or 96 hours after delivery, the provider will discuss this with the patient after they decide it is safe, and if agreed upon, an early leave is permitted. Regardless of the case, however, a provider has no legal right to receive incentives or disincentives to require an earlier release than 48 or 96 hours after birth.

State laws for childbirth vary, and your state may have similar hospital stay protections or your health plan may offer coverage through an insurance policy or HMO. If such is the case, you are protected by state law instead of the Newborns’ and Mothers’ Health Protection Act.

30 Day Enrollment Period

HIPAA has established a very important protection for children born into insured families, called “special enrollment” for qualifying events, including childbirth. If you qualify for a health plan, but do not have coverage through an employer, you, your spouse, and the new child after birth or adoption can apply for coverage in this way. Special enrollment does not follow the open enrollment schedule for a health insurance company or state guidelines, but it applies only in the context of an event, such as birth or adoption, occurring in the life of the policy holder(s).

In order to add your new child as a dependent on your health plan, you are required to enroll within 30 days (in some states 31 days) after the child is born. This rule also applies to the date of adopting a new child or placement for adoption. Coverage should be effective starting the date of the child’s birth, the date of adoption, or date of placement for adoption. HIPAA does not allow pre-existing condition exclusion periods to be placed on pregnant women, newborns, adopted children, and children placed for adoption within the 30 day enrollment window. If any exclusion period is issued, it has a legal limit of 12 months.

Insurance plans that abide by the HIPAA 30 day enrollment policy include all types of creditable coverage, such as employer-sponsored plans, individual health insurance, HMO plans, COBRA benefits, Medicaid, CHIP, Medicare, TRICARE, Indian Health Service, high-risk pools, Peace Corps plans, public health plans, and Federal Employees Health Benefit Plans.

 

Childbirth: Key Points

  • Pre-authorization is not a requirement in order to receive coverage for your delivery hospital stay.
  • If your plan offers maternity coverage, your hospital stay should be at least 48 hours after a natural birth and 96 hours after a cesarean section.
  • Always enroll your child as a dependent for your health plan within 30 days of the date they were born.
  • Your health plan is required to give you an outline of your rights related to a hospital stay after giving birth. If you have a plan through an insurance company, the document will explain state protections regarding your labor, delivery, and hospital stay length.
  • Contact your health plan at the soonest opportunity to get the child insured and find out how to enroll.
  • If you meet the 30 day enrollment period requirement, benefits should start the day of your child’s birth, and no pre-exsiting condition exclusions can be issued to the newborn on your plan.

 

Adoption: Key Points

  • Contact your health plan as soon as possible to get information on how to get the child insured.
  • If you enroll your child within 30 days of adoption or placement for adoption, coverage should begin on the date of adoption, and pre-exsiting condition exclusion periods cannot be applied to the adopted child’s benefits.
  • Enroll your adopted child as a dependent on your plan within 30 days of adoption or placement for adoption.