Case of the
'I Don't Have You Covered' -Solved

The answer can be found in Chapter 3, under the button Eligibility.

Newborns- State law requires that newborns be covered for the first 31 days of life. During this 31-day period, the child must be added to the plan and any applicable premiums must be paid. Dependents not added within the 31-day period might be subject to additional underwriting.

Little Dany was not covered because Renee failed to enroll her daughter into her company's health insurance. The portion of the bills paid by the health insurance carrier  were only done so because newborns are automatically covered for the first 31 days of life. But if Renee wanted Dany to remain covered beyond that period, she had to formally enroll her into her health insurance plan and begin paying any applicable premiums prior to the 31 day expiration.

Because Renee failed to enroll her daughter on time, her company refused to add baby Dany as a late enrollee. Dany was without insurance coverage until Renee's company held its next open enrollment period and Renee was forced to pay for all of Dany's care out of pocket.

Back to Case Study