Oxford
UnitedHealthcare® Oxford
Administrative Policy
NEWBORNS
Policy Number: ADMINISTRATIVE 036.13 T0
Table of Contents
Page
INSTRUCTIONS FOR USE .......................................... 1
APPLICABLE LINES OF BUSINESS/PRODUCTS .............. 1
PURPOSE ................................................................ 1
POLICY ................................................................... 1
PROCEDURES AND RESPONSIBILITIES ....................... 2
REFERENCES ........................................................... 3
POLICY HISTORY/REVISION INFORMATION ................. 3
Effective Date: November 1, 2016
Related Policies
None
INSTRUCTIONS FOR USE
The services described in Oxford policies are subject to the terms, conditions and limitations of the member's contract
or certificate. Unless otherwise stated, Oxford policies do not apply to Medicare Advantage members. Oxford reserves
the right, in its sole discretion, to modify policies as necessary without prior written notice unless otherwise required
by Oxford's administrative procedures or applicable state law. The term Oxford includes Oxford Health Plans, LLC and
all of its subsidiaries as appropriate for these policies.
Certain policies may not be applicable to Self-Funded members and certain insured products. Refer to the member
specific benefit plan document or Certificate of Coverage to determine whether coverage is provided or if there are
any exclusions or benefit limitations applicable to any of these policies. If there is a difference between any policy and
the member specific benefit plan document or Certificate of Coverage, the member specific benefit plan document or
Certificate of Coverage will govern.
APPLICABLE LINES OF BUSINESS/PRODUCTS
This policy applies to Oxford Commercial plan membership and Oxford USA membership.
PURPOSE
This policy outlines the applicable state regulations impacting Oxford's processes for the enrollment and coverage of
newborns.
Note: When calculating any of the time frames below, the newborn's date of birth is considered day zero.
POLICY
Services for newborns enrolled as Oxford Members are reimbursed in accordance with standard processing rules.
Preexisting condition limitations do not apply to newborns.
Newborn services include routine nursery care and the treatment of disease and/or injury (including treatment of
prematurity and medically diagnosed congenital defects and birth abnormalities which cause anatomical functional
impairment).
Dependent of a Dependent
Oxford does not provide coverage for the newborn of an enrolled dependent*.
Notes:

*Some employer group plans may offer coverage for Dependents of Dependents. Refer to the Member specific
benefit plan document to determine if this coverage is available.

According to the Statement of Rights under the Newborns' and Mothers' Health Protection Act for New York Lines
of Business Oxford will provide coverage for newborn services of an enrolled dependent. This is limited to 48/96
hours of routine nursery care under the mother's benefit. The child cannot be enrolled.
Newborns
UnitedHealthcare Oxford Administrative Policy
©1996-2016, Oxford Health Plans, LLC
Page 1 of 3
Effective 11/01/2016
PROCEDURES AND RESPONSIBILITIES
Connecticut Plans

Newborns will automatically be covered under the subscriber's policy for the first 61 days after birth whether or
not the child is enrolled. Failure to furnish notification or payment of premium shall not affect any claim for the
first 61 days.

If the subscriber does not have family coverage or is not maintaining parent/children coverage, the child must be
enrolled within the initial 61-day period in order for coverage to continue beyond the 61 days.

If the subscriber is enrolled in a family coverage or is maintaining a parent/children tier, the child is automatically
enrolled. The subscriber must provide Oxford with the newborn's name, gender, date of birth, Social Security
number, and selected Pediatrician either verbally or in writing.
New Jersey Plans
All New Jersey Plans (Excluding New Jersey State Employee Self-Funded plans)

The newborn is automatically covered for the first 31 days whether or not the child is enrolled. Failure to furnish
notification or payment of premium shall not affect any claim for the first 31 days.

If the subscriber does not have family coverage or is not maintaining parent/children coverage, the child must be
enrolled within the initial 31-day period in order for coverage to continue beyond the 31 days.

If the subscriber is enrolled in a family coverage or is maintaining a parent/children tier, the child is automatically
enrolled. The subscriber must provide Oxford with the newborn's name, gender, date of birth, Social Security
number, and selected Pediatrician either verbally or in writing.
New Jersey State Employee Self-Funded Plans

Health benefits may be continued beyond the 31-day period if the employee (subscriber) is already covered for
dependent child coverage on the date the child is born. Coverage automatically continues beyond the initial 31day period if the premium required for dependent child coverage continues to be paid. The employee is
responsible for notifying Oxford of the birth as soon as possible.

If the employee is not covered for dependent child coverage on the date of birth, then the employee must give
written notice to enroll the newborn and pay the premium required within 31 days of the date of birth. If this
notice is not given and the premium is not paid within those 31 days, then the newborn's coverage will end at the
end of the 31-day period. If the notice and premium are provided after the initial 31-day period, the newborn will
be considered a late enrollee.
New York Plans
Enrollment rules in New York vary based upon the product and line of business (LOB).
Note: According to NY State law, for all LOBs a newborn is automatically covered for the first 48 hours after a vaginal
delivery or for the first 96 hours after a cesarean delivery (coverage is limited to routine nursery care under the
mother's benefit). Thereafter, a newborn must be properly enrolled within 31 days of birth and premiums must be
timely paid in order for coverage to continue to exist beyond the 48 to 96 hours. However, benefits for perinatal
complications are considered benefits under the baby's coverage, and therefore, the baby would have to be enrolled
to receive these benefits pursuant to the NY mandate.
What Plan Does
the Subscriber
Have?
OHP
OHI
Is Family Plan or
Parent/Children
Plan in Place?
(Y/N)
Is Max
Premium
Being
Paid?
(Y/N)
Is Newborn
Automatically
Covered as of
Date of Birth?
(Y/N)
Y
Y
Y
N
N
N
Y
Y
N
N
N
N
What Must the Subscriber Provide to Us?
Newborn’s name, gender, date of birth, SSN
and selected pediatrician (either verbally or in
writing)
According to NY State law, for all LOBs, a
newborn is automatically covered for the first
48 hours after a vaginal delivery or for the
first 96 hours after a cesarean delivery
(coverage is limited to routine nursery care
under the mother's benefit). Thereafter, the
newborn will be covered for the first 31 days
following birth only if the Subscriber submits
the required proof specifically adding the
newborn child and submits any required
premium.
Newborns
UnitedHealthcare Oxford Administrative Policy
©1996-2016, Oxford Health Plans, LLC
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Effective 11/01/2016
What Plan Does
the Subscriber
Have?
Is Family Plan or
Parent/Children
Plan in Place?
(Y/N)
Is Max
Premium
Being
Paid?
(Y/N)
Y
Y
N
N
Oxford USA
Is Newborn
Automatically
Covered as of
Date of Birth?
(Y/N)
Y – for the first
31 days only
Y – for the first
31 days only
What Must the Subscriber Provide to Us?
The newborn will only be covered for more
than the first 31 days if the Subscriber
submits the required proof specifically adding
the newborn. The proof must be submitted
within the first 31 days.
The above provisions apply to newly born adopted children if the Subscriber takes physical custody of the child upon
its release from the Hospital and files a petition pursuant to section 115-c of the domestic relations law within 30 days
of birth, and provided no notice of revocation has been filed and consent for the adoption has not been revoked.
The child does not need to be present, in the Service Area, when it is placed in the physical custody of the Subscriber
in order for coverage to begin. However, if the Subscriber takes custody outside of the Service Area, coverage may be
limited to emergency and urgent care unless:

They have access to an extended network of participating providers, or

The Subscriber's plan has out-of-network coverage
REFERENCES
Connecticut- 38a-516.
New Jersey- NJ 17B: 27-30.
New York Code §4235(f)(2).
New York Insurance Department Opinion of Counsel, April 8, 2008.
Oxford Certificates of Coverage.
POLICY HISTORY/REVISION INFORMATION
Date
11/01/2016



Action/Description
Reformatted and reorganized policy; transferred content to new template
Updated supporting information to relfect the most current references; no change
to policy guidelines
Archived previous policy version ADMINISTRATIVE 036.12 T0
Newborns
UnitedHealthcare Oxford Administrative Policy
©1996-2016, Oxford Health Plans, LLC
Page 3 of 3
Effective 11/01/2016