State RegulationsTX specificDifficulty 2/5
A Texas insured's baby is born. The insured does not notify the plan of the birth for several weeks and has not yet paid the additional premium. Under the Texas newborn coverage requirement, what is the effect?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under TIC 1367.003 and 28 TAC 3.3403, the child's coverage attaches at birth and is not defeated by delayed paperwork. What the plan may do is condition the continuation of that coverage on receiving notice of the birth and any additional premium the plan's terms require. The distinction matters in practice: the insurer may chase the premium and eventually terminate for nonpayment, but it may not go back and erase coverage that already ran from birth.
Why the other options are wrong
- B) Coverage is not postponed to the date the plan receives the paperwork; the effective date is the birth.
- C) A retroactive rescission back to birth is inconsistent with a mandate that fixes coverage at the moment of birth.
- D) Late notice and unpaid premium affect continuation, not the existence of coverage that began at birth.
Memory hook
Late paperwork does not erase coverage that already began at birth.