3rd Trimester

Anyone knowledgable about insurance (HIPPA, Qualified Change in Status)?

Sorry, this is long, but since insurance is complicated, I want to be sure I'm clear on everything. 

I am on my own insurance plan currently which will cover me through the birth (and beyond if I want it), but as I intend to stop working after the baby is born am looking at options other than COBRA continuation of my current benefits as they are extremely pricey.

I know that once the baby is born he can be added to DH's insurance without any problem. My question is, does this qualified change in status qualify me to be added to his plan as well or just the baby? According to this excerpt from the Department of Labor website, it sounds like, yes, I should be eligible as well:

"How does giving birth to or adopting a baby affect my rights to enroll in my health plan or health insurance coverage?
Under HIPAA, you, your spouse, and your new child have a special right to enroll in your health plan upon the birth, adoption, or placement for adoption of your new child, if you, your spouse, and your new child are otherwise eligible to enroll in the plan. You must request enrollment in the plan within 30 days of the birth, adoption, or placement for adoption. Your plan or insurance issuer may not treat your or your spouse as a late enrollee in this circumstance. So, for example, the longest preexisting condition exclusion that could be imposed on you of your spouse is 12 months. Your family's coverage under this type of special enrollment must be effective as of the date of the birth, adoption, or placement for adoption." 

The issue I'm having is that the entire website is written to the new mother as the policyholder. So, I'm not sure if the rights are exactly the same if my spouse is the policyholder and not me. (Here is the website).

DH works for a huge company so navigating through to get all the answers has been complicated. This is my project for today - even if I have to sit on hold for an hour. Any insight you ladies have would be great. 


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Re: Anyone knowledgable about insurance (HIPPA, Qualified Change in Status)?

  • Ditto, you quitting your job is a qualifying event for you since you lose coverage so you can move to your DH's plan then. 
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  • You also want to make sure you notify the company promptly.  If you wait too long after your termination date they can make you wait until open enrollment.  The eligibility period after the qualifying event could be as short as 30 days.
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  • It also depends on whether your hubby's work has a specific period of time in which he can add on to his policy.  He may be able to add baby right away but I know that some employers only have a certain time in which employees are able to change their policys. (open enrollment).  You probably would be better off calling hubby's HR and talking with them directly. 
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  • What Buffy said. When #1 was born DH and I were on separate policies.  His birth qualified him to go on either policy, but we couldn't go to a family plan until open enrollment.  We all went on my plan at enrollment.

    When I resigned mid-year it was a qualifying event for us to all go on DH's plan.

  • imagebuffyanne02:

    Okay, your lucky day. I sit next to HR people. :)

    A birth is a qualifying event just for the baby, not for other members of the family. BUT if you are planning to quit work, then that in itself is a qualifying event and will allow you eligibility on your husband's insurance.

    Does that help?

     **ETA** As I was talking through my cube wall to my coworker, I repeatedly said that this wasn't in regards to me. She started laughing and called bullsh!t. Hah.

    This! I'm in HR as well.  The loss of your job qualifies you to be added to his plan.

  • image2thpiker:
    It also depends on whether your hubby's work has a specific period of time in which he can add on to his policy.  He may be able to add baby right away but I know that some employers only have a certain time in which employees are able to change their policys. (open enrollment).  You probably would be better off calling hubby's HR and talking with them directly. 

    Believe me, I've been on hold with them for 30 minutes :-). They are generally very helpful, but you sometimes have to wait a while to speak with them.

    Thanks for the info ladies!

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  • I work in HR.  Our company would allow the employee to add the spouse and child on a birth event.  You have 30 days to notify us of the change.  We'd also allow the employee to add a spouse if the spouse loses employment.  Either way, you should be covered.  Some companies will only allow the addition of a child for a birth/adoption event--some companies are more generous than what they must provide.  Your husband should call his HR department and find out what they'll need.  You may need proof that your employment has terminated.
  • Ditto on the above. It's a qualifying event for your baby, at birth. It sounds like you too can be covered since you're currently on COBRA coverage and the premiums are paid by you, not by your employer. I'm sure that once your coverage ends you can switch to your DH's plan. If your DH is on an employer paid policy, then he can ask his HR department for the specifics, since each company and policy have different eligibility requirements.

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