Effective July 1, newborns must be enrolled to receive coverage
Effective July 1, 2017, for all commercial plans, parents must add newborns to their Priority Health plan to receive coverage. Newborns will no longer be automatically covered for the first days of life under the mother's member ID number. This change is in accordance with the state insurance code update in 2016 that states insurers aren't mandated to automatically provide coverage to newborns.
Up to this change, we have provided three days of coverage for healthy newborns and 30 days of coverage for unhealthy newborns under the mother's policy without collecting any premiums for the newborn. All this claims processing is done completely manually and leaves Priority Health at risk for treating members differently or making errors.
Other Michigan health plans have enacted this same change recently. BCBS and BCN announced their newborn policy change on 4/1/17 to the network.
Claims will reject, members can appeal
After July 1, claims submitted for newborns who are not yet enrolled as dependents of their parent/guardian's plan will reject. Members can appeal rejected claims for newborn coverage in accordance with the standard process, which can be found in the Reviews & appeals section.
Members have been notified
All subscribers in our commercial groups, with the exception of self-funded groups, and all subscribers enrolled in MyPriority® plans were notified of this policy change the week of June 25, 2017.