Under TIC 1367.003, a health benefit plan that provides maternity benefits or coverage for newborn children may not exclude or restrict coverage for which of the following?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
TIC 1367.003 provides that a health benefit plan that provides maternity benefits or coverage for newborn children may not exclude or restrict coverage during the newborn's initial coverage period, coverage for congenital defects and birth abnormalities, or coverage for required newborn screening. The protection is a defined window plus a defined set of benefits, not a mandate to cover everything connected with a birth. For a Texas agent, the practical point is that the statute guarantees the newborn's initial coverage and screening; it does not extend to the mother's maternity care or to the insured's other children.
Why the other options are wrong
- A) The statute protects the newborn's initial coverage period, not the period after it ends. Once that initial period has run, the plan's ordinary terms govern the child's care.
- B) Maternity benefits for the insured during pregnancy are outside this provision. The statute is directed at the newborn child's coverage, not at the insured's own maternity care.
- D) Coverage for the insured's other children is governed by the plan's dependent eligibility provisions, not by the newborn coverage statute.
Memory hook
Protect the newborn's initial window, not everything around the birth.