Members with Individual, Employee/Spouse or Parent/Child contracts must submit an Enrollment/Change form to add a newborn, and change their plans to Parent/Child, Parent/Children or Family coverage (and pay the premium) within sixty (60) days after the date of the baby's birth for coverage to be retroactive to the date of birth. Claims submitted before the newborn is enrolled under the correct contract type will be denied. These claims will be reprocessed once the newborn is enrolled, as long as it is within 60 days of the birth.
If Empire does not receive the Enrollment/Change form within 60 days after the baby's birth, coverage will begin on the actual date we receive the completed form, as long as we receive it during the next open enrollment period after the birth, or during the first year after the birth, whichever occurs first.
If we do not receive the Enrollment/Change form after the next open enrollment period after the birth, or after the first year of birth (whichever occurs first), coverage is not available until the next open enrollment period.