The Omnibus Budget Reconciliation Act of 1993 (OBRA'93), Public Law 103-66, amended the Employee Retirement Income Security Act of 1974 (ERISA). The amended law requires that any group health plan which provides coverage for dependent children must provide benefits to a child placed for adoption under the same terms and conditions as apply to a child who is the biological child of a plan participant. OBRA'93 specifically eliminated any requirement that the adoption be finalized in court before there is coverage. The new law also prohibits carriers from restricting coverage of adopted children on the basis of a preexisting condition. The changes implemented by OBRA'93 apply to the medical benefit plans of all employers subject to ERISA. Since ERISA covers almost all employers except government employers, OBRA'93 provided broad coverage to families with adopted children. Basically, although your HR dept and the insurance company may tell you otherwise, insurance is required to cover an adopted newborn just as they would a baby born to you.

For your adopted children to be entitled to coverage under your employer's health insurance plan you must be a plan participant and you must otherwise be eligible to elect family coverage under the plan, and you must follow any other requirements for coverage under the plan.
 
Some insurance companies may argue that agency's placement papers are not sufficient to initiate adding the child to your insurance because a court did not issue them. You may need to explain to your insurance company that the court does not "place" children for adoption nor do they make "adoption placements" but agencies and/or birth parents do. It is for this reason the legislation was drafted using alternative language to include children who are in placed into adoptive parent(s)' custody "pursuant to an interim court order or placement of adoption". I explain that if the legislature intended the statute to mean "court ordered placement of adoption" it would have written it that way instead of using the words "or placement".
 
Agencies can and do grant temporary custody to adoptive parents through legally valid placement agreements. These instruments obligate prospective adoptive parents to be responsible for the child's medical health and to consent to all major medical procedures. The reason the statute distinguishes between an Interim Order (the order that is first entered into when clients make their first appearance in court) is because the legislatures and parties to adoption proceedings know that adoptive placements are made prior to going into court. Most often adoptive placements are made weeks prior to going into court for the Interim Order.
 
If your insurance company or employer is denying your child coverage, you should address these issues in writing and go up the chain of command and deal directly with supervisors, etc. I recommend you email or fax letters as well as mail them to expedite matters. If you receive a denial letter, request an appeal immediately. Retain counsel if needed.

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HELPFUL LINKS

https://www.healthcare.gov/blog/special-enrollment-period-child-birth/

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