State RegulationsTX specificDifficulty 1/5
Under the Texas newborn coverage requirement, a health benefit plan's coverage of an insured's newborn child begins:
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under TIC 1367.003 and the TDI rule at 28 TAC 3.3403, a health benefit plan that covers a newborn child must cover that child from the moment of birth. The child is therefore covered for injury and sickness from birth, and a claim cannot be denied merely because notice of the birth or the enrollment paperwork had not yet reached the insurer. Notice of the birth and payment of any required premium are conditions of continuing the coverage, not of starting it.
Why the other options are wrong
- A) Coverage is not deferred to a monthly entry date or any other future date; it begins at birth.
- B) Notice of the birth is a condition the plan may impose for continuing coverage, but coverage begins at birth, not when the insurer receives notice.
- D) Enrollment is an administrative requirement; it does not delay the child's coverage, which runs from the instant of birth.
Memory hook
Born covered: coverage starts at birth, and paperwork only keeps it going.