HMSA follows our Maternity – Length of Stay policy to process newborn baby delivery hospital services/claims. However, if another carrier is involved, that carrier may have a different newborn policy. The table below addresses dual coverage (DC) situations where another carrier’s newborn policy differs from HMSA’s and provides coordination of benefit (COB) impacts.
If the other carrier is TRICARE, the HMSA plan will always be primary, even if the newborn is NOT listed as a dependent on either plan.
| # | Parent’s Plan | Carrier | Baby Listed Dependent | Primacy Rule | COB |
|---|---|---|---|---|---|
| 1 | Father’s | Other | Yes | Birthday Rule* | Yes |
| Mother’s | HMSA | No | |||
| 2 | Father’s | Other | Yes | Birthday Rule* | Yes |
| Mother’s | HMSA | Yes | |||
| 3 | Father’s | HMSA | Yes | OPL to contact other carrier | Yes |
| Mother’s | Other | No | |||
| 4 | Father’s | HMSA | Yes | Birthday Rule* | Yes |
| Mother’s | Other | Yes | |||
*Birthday Rule: The parent who has the earlier birth month and day in the calendar year is primary for the newborn. If both parents have the same birth month and day, then the plan that has earlier effective date (for the subscriber of the plan) is primary.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |