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Newborn Enrollment

According to the NY Insurance law and the federal Newborns and Mothers Act a health plan must pay for inpatient care for a newborn's first 48 hours (vaginal delivery) or 96 hours (c-section delivery), without regard to whether the newborn has been enrolled under the plan.  
For coverage beyond the initial inpatient nursery care, all newborn children must be enrolled as dependents within 60 days of birth* in order to ensure coverage with no claims processing delays.  

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.

Members with Family or Parent/Children contracts have coverage for newborn children but MUST submit an Enrollment/Change form to add the newborn to the benefit contract. Coverage is effective from the newborn's date of birth provided that the newborn is enrolled.

*Your Plan’s special enrollment period may vary from this provision. Please check your plan document for the specific enrollment period applicable.  
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Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., and/or HealthPlus, LLC., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans, serving residents and businesses in the 28 eastern and southeastern counties of New York State. All external sites will open in a new browser window. Please view our Website Privacy Policy for more information.