Can the health insurance company actually deny coverage for our newborn?

Question

My wife has been covered by her employer's health plan through Blue Cross Blue Shield of Tennessee. She recently gave birth to our son on April 22nd. She technically quit her job on April 16th.

Human resources told us that she would be covered until the end of April, after which we planned on using COBRA. Human resources told us all we had to do was notify them ASAP after the baby's birth to get him on the plan.

So we did exactly as they told us, but today human resources department just told us they can't put our son on her plan because she is listed as having quit, even though her insurance will continue until the end of the month. They said they would call the insurance company, but they made it seem like he most likely wouldn't be allowed on the plan.

Can this be true? She is covered until the end of the month and then we're going to pay for continuing coverage through COBRA. How could they not let my child on the plan?!?!

Any experts out there that can offer advice?

Answer 1

It is entirely possible that the Human Resources department is no longer able to handle the issue between you and the insurance carrier, however your baby can ABSOLUTELY be covered under your wife's insurance plan.  Or yours, for that matter, at your preference.

You may need to get the form from Human Resources (or Blue Cross Blue Shield) and send it in directly, but there is no cause for concern other than a delay.  Get that form in, and put your concerns to rest.

Answer 2

why did she quit? she would've been able to take a leave for childbirth which would have made her an employee still and eligible for the insurance coverage...I don't know but while my daughter was out on maternity leave her company was bought by another company which ended her insurance, it was after the hospitalization thank goodness, but really messed her up as far as her follow up visits. she then applied for state coverage for the baby  ie blue cross all kids, they go by your income and have a pretty high limit, you might want to check that out, it's a lot cheaper, but will still take some time to get it all done...good luck

Answer 3

Well, part of it is true.   She has to sign up for Cobra, and then call the Cobra administrator to add the child.  

The employer can't add the baby on.

Answer 4

Any child born to or placed for adoption with a covered employee during the period of COBRA coverage is considered a qualified beneficiary. In this case there may be some confusion by the HR department because it also states: "A qualified beneficiary generally is an individual covered by a group health plan on the day before a qualifying event (termination of employment) who is either an employee, the employee's spouse, or an employee's dependent child."

Here is the link to the government website: http://www.dol.gov/ebsa/faqs/faq_consume...

You should look into getting a private policy unless your wife or the baby is uninsurable. The premium for a private policy can be much less expensive. Visit a local independent agent that works with all the major plans in your area. There is no extra charge using an agent.