Employee Benefits Question of the Week: Newborns’ and Mothers’ Health Protection Act

QUESTION: Does a plan have to cover a newborn baby under the Newborns’ and Mothers’ Health Protection Act (NMHPA) if the newborn is not added to the policy?

ANSWER:    The plan need not cover anyone who is not enrolled.  The NMHPA does not require group health plans to provide coverage for maternity or newborn benefits.  HIPAA affords newborns at least a 30 day window to be enrolled in the plan, starting at birth; coverage will be retroactively effective as of the birth.

Generally, the mother’s inpatient stay and delivery itself are covered under the mother’s benefits, but beyond that, any treatment for the newborn would be under the newborn’s own coverage (if enrolled).

Source: The Phia Group

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