State RegulationsTX specificDifficulty 3/5
A Texas health benefit plan provides coverage for the insured only and does not provide coverage for any family member. The insured's child is born. Which statement is correct?
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
TIC 1367.003 and 28 TAC 3.3403 attach the newborn coverage requirement to health benefit plans that provide coverage for a family member of the insured; where the plan covers only the insured, there is no dependent coverage for the mandate to extend. The insured may still be able to add the child later under the contract's own enrollment provisions, but that is a matter of the policy's terms, not of the statutory newborn mandate, a distinction agents should explain before a client assumes the birth is automatically covered.
Why the other options are wrong
- A) Automatic free addition of a dependent is not required where the plan provides no family coverage; the mandate in TIC 1367.003 depends on the plan covering family members.
- C) Where the plan covers only the insured, the newborn mandate is not triggered, so no coverage for congenital defects arises from it.
- D) Nothing in the newborn coverage requirement compels the insurer to issue a separate policy to the child.
Memory hook
No dependent coverage in the plan, no newborn mandate to extend.