Marketplace/ACA Health Plans
If you are expecting to or have recently added a child to your family, whether by birth or adoption, it is important to review your life insurance and disability income protection insurance. We also recommend checking with your health insurer before the birth or adoption to make sure that you understand what you need to do in order for coverage to begin. You may need to contact the insurer after your child's birth or placement for adoption occurs and within a certain time period, typically within 30-60 days.
It is also important prior to the birth or adoption of your child to decide, if there is more than one insurance policy that can cover the child, whose insurance you want the child to be insured under. This is important to be sure you are following any requirements that policy and insurer may have to begin coverage for your child.
Make sure to understand the “birthday rule." A child who can be covered by two or more health insurance policies (parents have separate policies) must take as primary coverage the plan of the parent whose birthday comes first in the calendar year, not the age of the parent but just whose birthday comes first in any year; the other parent's insurance is considered secondary. Understanding how the policies coordinate before the birth can help you avoid costly bills.
If you are covered by a Marketplace health plan, make sure you contact your insurer within 30 days after your baby's birth or placement for adoption to add your child to the policy. Understand there may or may not be additional premium required to cover your child.
NOTE: Coverage in WI begins upon placement for adoption (not final adoption).
Maternity care and newborn care services provided before and after your child is born are essential health benefits. This means all qualified health plans inside and outside the
Marketplace must cover them.
If you recently gave birth and don’t have health coverage, having a baby qualifies you for a Special Enrollment Period. This means that after you have your baby you can enroll in or change Marketplace coverage.
Make sure you apply within
60 days after your baby’s birth or adoption.