Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter U - NEWBORN CHILDREN COVERAGE › Section 3.3403 - General Rules of Application

Current through Reg. 49, No. 28; July 12, 2024
(a) No individual
				  policy or group policy of accident and sickness insurance which provides for
				  accident and sickness coverage of additional newborn children may be issued in
				  this state if it contains any provisions excluding or limiting initial coverage
				  of a newborn infant for a period of time, or limitations or exclusions for
				  congenital defects of a newborn child.
(b) No individual policy or group policy of
				  accident and sickness insurance which provides for maternity benefits may be
				  issued in this state if it contains any provisions excluding or limiting
				  initial coverage of a newborn infant for a period of time, or limitations or
				  exclusions for congenital defects of a newborn child.
(c) If the policy provides accident and
				  sickness coverage for newborn children, such coverage must be at least as
				  comprehensive as the coverage provided under the policy for other children for
				  loss as a result of an accident or sickness.
(d) If the policy provides maternity
				  benefits, and included in such benefits are coverages for newborn infants, such
				  policy may not contain any provision excluding or limiting initial coverage of
				  newborn infants for a period of time, or limit or exclude coverage for
				  congenital defects of a newborn child.
(e) The initial coverage provided newborn
				  children must continue for a period of at least 31 days. The insurer may
				  require that before the coverage continues beyond this initial 31-day period,
				  the policyholder must notify the insurer of the birth of the newborn child and
				  pay any additional premium required to maintain the coverage in force. Any
				  additional premium required for the initial period of coverage may be
				  charged.
(f) Insurance Code §
										1367.003
				  applies to all accident and sickness policies issued or issued for delivery,
				  renewed, extended, or amended in the State of Texas on and after January 1,
				  1974. The insurer, upon a renewal, extension, or amendment, may charge such
				  additional premiums as are just and reasonable for the additional risk incurred
				  by compliance with Insurance Code §
										1367.003.
				  With respect to any policy forms approved by the Texas Department of Insurance
				  prior to the effective date of §1367.003, an insurer is authorized to
				  achieve compliance with §1367.003 by the use of endorsements or riders
				  provided such endorsements or riders are approved by the Texas Department of
				  Insurance as being in compliance with Insurance Code §
										1367.003
				  and other provisions of the Texas Insurance Code.
(g) Insurance Code §
										1367.003
				  applies to policies written before January 1, 1974, if and when such a policy
				  is "renewed, extended or amended" after January 1, 1974. If the provisions of a
				  policy written before January 1, 1974, allow the insurer to renegotiate the
				  terms of the policy after January 1, 1974, or allow the insurer to adjust the
				  premiums charged under the policy after January 1, 1974, and if at the time
				  such renegotiation or adjustment could be accomplished and is accomplished, the
				  policy continues in force or a policy with substantially similar coverage is
				  agreed to by the insured and insurer, then the policy will be said to have been
				  "renewed, extended or amended" for purposes of Insurance Code §
										1367.003,
				  and the requirements of §1367.003 will attach to the policy.
(h) Insurance Code §
										1367.003
				  applies to any policy except a "non-cancellable and guaranteed renewable"
				  policy written before January 1, 1974, if such policy is "renewed, extended or
				  amended" or a rate adjustment could be made after January 1, 1974. If a group
				  policy is written in conjunction with a collective bargaining agreement, such
				  policy will be considered "renewed, extended or amended" upon the expiration of
				  any applicable collective bargaining agreement.
(i) Nothing in this subchapter will be deemed
				  to extend the provisions of Insurance Code §
										1367.003
				  to insurance contracts providing benefits only for specified diseases, pure
				  accident policies, disability only policies, or loss of time only
				  policies.