So my wife and I are expecting our first child in November and we are on the older side for first time parents (i’m 42, she’s 40) so while things are going well so far, we know that things are always high risk for us, so I was just reading about NICU stays and costs involved and ran into the birthday rule. My question is whether in our situation, it is worth it for me to drop my insurance and see if i can get added on to my wife’s plan… here are the details:
I have a high deductible plan ($2500) through work and put in money to an HSA – from what I can tell, the hospital we plan on giving birth in is out of network for my plan so it seems that the deductible jumps from $2500 to $9000 if out of network
My wife has a better plan through her job that has no deductibles and our hospital is in network
From what I understand from reading up on the subject, the birthday rule states that my insurance plan would be the primary plan for our baby as soon as he is born since my birthday (12-10) is before my wife’s (12-31) so if he needs NICU care in the hospital, it seems we would owe a lot more under my plan
The part that is confusing me is the stipulation i read that says
* The secondary plan pays any remaining costs not covered by the primary plan — but only if the medical care is a “covered benefit” under the secondary plan.
So does that mean that if my insurance would have a $9000 deductible for a NICU stay, would that then be covered by my wife’s plan? Some of the sites i’m looking at also seem to say that if the primary plan is not as good as the secondary plan, then it would be worth it for the spouse with the primary plan to drop it and get on the other plan before the child is born but why would you do this if the secondary plan would cover anything not covered by the primary plan?
Any advice would be appreciated, i’m not great on insurance lingo and interpreting fine print – thanks!