North Carolina newborn insurance coverage
Over the course of the year, we have received many inquiries from people wanting to know when a North Carolina newborn can get insurance coverage through the health insurance marketplace. As many people may be aware, most marketplace enrollments are effective the 1st day of the month following the date of enrollment.
However, for newborn children in North Carolina who need insurance coverage, a Special Enrollment Period or SEP is available that will provide coverage effective on the date of birth! This is great news for new parents worried about the hassle of getting a newly born child insured.
What is a a Special Enrollment Period? A special enrollment period is when you have a qualifying life event that allows you to enroll in coverage on or off of the marketplace, outside of open enrollment. Of course, giving birth to a child is one of the many life events that would qualify you for a Special Enrollment Period.
Below is the specific guidance, directly from CMS, that details how Special Enrollment Periods for Nouth Carolina newborn insurance coverage work:
Per 45 CFR §155.420, Special Enrollment Periods (SEPs) constitute periods outside the initial or annual
open enrollment when a QI may enroll in a QHP and QDP or a QI can elect to change a current QHP and
QDP selection as a result of a triggering event, such as birth/adoption, relocation, death, or loss of MEC.
It is the responsibility of the FFMs to determine whether a QI meets eligibility requirements for a SEP.
The FFMs determine eligibility for SEPs, which are described by regulation at 45 CFR §155.420(d). In the
individual market FFMs, Special Enrollment Periods generally last 60 days from the triggering event, per
45 CFR §155.420(c). In SHOPs, including FF-SHOPs, Special Enrollment Periods generally last 30 days
from the triggering event, although there are two exceptions, when an enrollee loses Medicaid or CHIP
coverage and when an enrollee becomes eligible for Medicaid or CHIP coverage For the Medicaid and
CHIP exceptions the SEP is 60 days. The start date of an SEP is based on the date of the triggering event.
Although certain SEPs adhere to the standard effective dates described earlier in section 1.2, there are
exceptions to this rule. For example, for birth, adoption, placement for adoption, or placement in foster
care, coverage is retroactive to the date of birth, adoption, placement for adoption, or placement in
North Carolina Newborn Health Insurance Coverage enrollment example:
Example : An enrollee contacts the Marketplace on 09/25/2014 to inform the Marketplace of the birth of
twins on 09/01/2014. The Marketplace does a redetermination of the enrollment group. The Marketplace sends
an 834 change transaction to the selected Qualified Health Plan adding the newborn children with a coverage
effective date 09/01/2014.
Do you need help with North Carolina newborn insurance coverage?
Of course, if all of this sounds complicated, please call (843.882.7062) or email us directly. or leave a comment. We can HELP!