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I don't know about adding the babe prior to coming home-- our agency said nothing of the sort (would think there would be "issues" at least prior to PGN finalization). We added her as a birth child after she came home. We ended up using DH's insurance for her giving us a 30 day window, but had a 90 day window with mine. Perhaps give your insurance a call? Not sure how they'd bill for a child who's not officially yours in another country. Does your fee not cover medical visits?
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Referral of 4 day old BG 4/07/05
Home forever 11/09/05 
lovin' family life since
June 2006: found a waiting child and starting the process to bring him home
born 4/27/03
8/22/07--home
April 2009: decided to pursue an Ethiopian adoption for "baby sister"
9/9- CIS approval
9/17- officially on the wait list~hopefully 8-10 months
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