Under the Texas HMO statute, if children are eligible for coverage under an HMO's evidence of coverage, what limiting age applies to coverage of an enrollee's unmarried child, including an unmarried grandchild?

Why B is correct

Under TIC 1271.006, if children are eligible for coverage under the terms of an evidence of coverage, any limiting age applicable to an unmarried child of an enrollee, including an unmarried grandchild of an enrollee, is 25 years of age, and the limiting age must be stated in the evidence of coverage. Subsection (b) separately permits an HMO to provide benefits to an enrollee's dependent grandchild who lives with the enrollee. Note that the age-26 figure familiar from the federal ACA dependent-coverage mandate is a different body of law; the Texas HMO statute's figure is 25.

Why the other options are wrong

• A) Eighteen is the minimum age for an insurance license, not the HMO dependent-child limiting age.
• C) Twenty-four is close but is not the statute's figure; TIC 1271.006 sets the limiting age at 25.
• D) Thirty is not the limiting age; the Texas HMO statute fixes the dependent-child limiting age at 25.

Memory hook

HMO dependent kids reach the ceiling at 25, and the EOC must say so.