Billing Policy for Newborns and Adoptees

For Arizona Brokers

The Arizona Department of Insurance has advised Health Net of Arizona, Inc. and Health Net Life Insurance Company (Health Net) that based on Sections 20-1057, 20-1342, 20-1402 and 20-1404 of the Arizona Revised Statutes, health plans must automatically cover a Subscriber’s newborn or adopted child for the first 31 days following the date of birth, the date of adoption or the date of placement. These provisions apply to all individual and Marketplace plans, as well as all other fully insured group plans in Arizona.

 

During the first 31 days following birth, adoption or placement for adoption, the health plan may not charge a premium for the newborn or adoptee when added to a Subscriber’s plan. Health plans may charge premium during the first 31 days on a child only plan.

The Arizona DOI has directed Health Net to review our records and determine if we have improperly charged premium for any newborns or adoptees during the first 31 days.

Health Net has discovered that during 2014, we have billed some AZ individuals and groups incorrectly. As a result, Health Net has credited the group’s bill and in the case of IFP and individual plans purchased through the Marketplace, provided a refund to the Subscriber. Groups and individual Subscribers may have already received notice of the credit or refund.

For group plans purchased through the Federal Marketplace, please be aware that the Marketplace will continue to collect premium for the first 31 days following birth, adoption or placement for adoption. Health Net will credit the group’s account within 3 – 4 weeks for any premium amount for a newborn or new adoptee that was billed incorrectly.

If a group has collected an employee contribution for a newborn or newly adopted child in error during the first 31 days, a credit may be due to the employee. We recommend that the group consults with its legal counsel to determine the appropriate action.
Please contact Health Net’s Billing Department at 1-800-723-6977 (option 2 for IFP, and option 4 for Group plans) if you have any questions.

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Mike Spasoff