Adding Newborns to Coverage

As a reminder, members have the option to add a newborn to the State Health Plan on the first day of the month in which the child is born or on the first day of the second month following the date of birth. Please make your employees aware of both options and what effect it will have on their premium and the coverage for the newborn based on the option they choose.

If an employee adds a newborn on the first day of the month in which the child is born and they have employee-only or employee-spouse coverage, their coverage type will change.  The member will be responsible for paying the additional premium for the month in which their child was born.  Because most employees wait to add their newborn until after the baby is born, it usually results in premiums for two months being deducted from one paycheck. 

The well baby hospital charges  are covered under the mother’s maternity benefits if she is enrolled on the State Health Plan.  The newborn must be enrolled to receive coverage for any additional health care, including office visits and immunizations.  Therefore, if the member chooses to enroll the newborn the first day of the second month following the date of birth, and the newborn receives any other health care services or sick baby care in the hospital prior to the effective date of coverage (the first of the month following the child’s birth), the member will be responsible for paying the full amount of any claims submitted for the newborn. 

Please see the Family Planning section in the Benefits Booklet to get further information on newborn care.