Qualifying Life Event: Newborn Coverage

Whether your baby has already arrived or you’re planning for the future, we’re excited to welcome them to the Sana family. We’re here to make the insurance process easy so you can focus on the things that matter most.

Newborn Coverage

Your newborn is eligible for coverage under your Sana plan from the moment they arrive. We understand that welcoming a new baby is a busy and exciting time. We’re here to make the insurance process easy so you can focus on the things that matter most!

During the first 30 days of your newborn’s life, you can add them as a dependent and update your coverage through a special enrollment period called a Qualifying Life Event. Once they are added to your plan under the QLE, their coverage will be backdated to their date of birth. Please note that Sana does provide temporary coverage for your newborn under the primary subscriber's plan within the first 30 days. This will ensure that there is no gap in coverage while you complete the enrollment process for your baby. 

Once your newborn is enrolled, they'll have their own individual coverage with a separate deductible, coinsurance, and out-of-pocket maximum.  Preventive care, including immunizations and well-baby visits, is always 100% covered, regardless of your plan. The 30-day coverage period for newborns is a grace period. To ensure your newborn is covered under your policy and to avoid any claims being denied, it's important to report the birth within 30 days. After this period, any claims will be processed under the newborn's information, not the parent’s. Please make sure to enroll your child within 30 days to ensure continuous coverage.

Note on coordination of benefits: Coordination of benefits may be required if two parents have different insurance policies at the time of birth or if the newborn is enrolled in two policies after birth.

• In these instances, the insurance determined to be the primary payer will pay first, and the secondary payer will pay their allowable less what was already paid by the primary.
• The parent whose birthday is earliest in the calendar year will be considered primary, except when the parents were never married, are separated, or are divorced.
• Our Customer Support team can assist with any questions regarding the coordination of benefits.

Qualifying Life Event - Process For Newborns

The handling of newborn claims depends more on whether or not the newborn had coverage on the day the claims are received. This is usually because of how long it takes for a newborn to be added to the plan (when Sana is informed of the qualifying life event). Once the newborn is added to the plan, the coverage start date is backdated to the qualifying life event (in this case, the birth date).

Coverage is backdated to ensure no gap in coverage; the effective date of the qualifying life event must be the birthdate.

Claims Situations

• The policyholder is assigned the claims as long as the date of service is within 30 days and the claims are received within those 30 days. However, the policyholder is assigned the claims only if there is no coverage for the baby within those 30 days.
• If a claim is received and coverage is already on file, even if it is within 30 days, it will be assigned and processed under the newborn.
• If the newborn hasn't been added yet.
• If the newborn is added anytime within the first 30 days.

Newborn Care

To Find Care, sign in to your Sana account to search Care Partners, contracted providers, and access to 1.4 million provider locations through affiliate networks.

Our Sana Care partners can help with your new parenting journey

• Sign up for Maven to take advantage of 24/7 access to 30+ specialties to assist during the newborn phase up to six months. Services include virtual urgent care, lactation consulting, sleep coaching, emotional well-being resources, peer support, and more. Maven services are free with your plan.
• Claim your baby’s Blueberry Pediatrics medical kit once you enroll them as a dependent. Did you know that 33% of Blueberry virtual visits happen after hours when your usual pediatrician’s office is closed? The Blueberry team can answer your questions, big or small, and can even peek in your little one’s ears and write prescriptions —  24/7, 365 days a year, including holidays.