A Texas group health benefit plan covers an employee and the employee's spouse. The employee's child is born while the coverage is in force. When does coverage for the newborn child begin?

Why A is correct

Under 28 TAC 3.3403 and TIC 1367.003, a health benefit plan that provides coverage for family members must cover a newborn child from the moment of birth, including necessary care and treatment of medically diagnosed congenital defects and birth abnormalities, and it may not condition that coverage on evidence of insurability or on a waiting period. The insurer may require notice of the birth and payment of the additional premium from the date of birth, so the agent's job is to push the client to report the birth promptly rather than to reassure the client that nothing is needed.

Why the other options are wrong

• B) Evidence of insurability cannot be required for newborn coverage under 28 TAC 3.3403 and TIC 1367.003; coverage runs from birth.
• C) A waiting period may not be imposed on the newborn; the statutory coverage attaches at the moment of birth.
• D) Coverage is not deferred to hospital discharge; it begins at birth and includes needed care and treatment of congenital defects and birth abnormalities.

Memory hook

Coverage starts at birth, no exam and no wait.