State RegulationsTX specificDifficulty 3/5
Under TIC 1367.003, the prohibition on excluding or restricting newborn coverage applies to which health benefit plans?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
TIC 1367.003 attaches to a health benefit plan that provides maternity benefits or coverage for newborn children, and bars such a plan from excluding or restricting the newborn's initial coverage period, congenital defects and birth abnormalities, and required newborn screening. The trigger is the content of the plan, not the market in which it is sold or whether the coverage is group or individual. A Texas agent should therefore check whether the contract actually carries maternity or newborn benefits before advising a client about the statutory protection.
Why the other options are wrong
- A) The provision is not limited to Marketplace plans. It applies wherever a health benefit plan provides maternity benefits or coverage for newborn children.
- B) The provision is not confined to group coverage. Whether the plan is a group or an individual plan does not determine whether the statutory protection applies.
- C) The provision is not confined to individual coverage either. The trigger is the plan's maternity or newborn benefit content, not the market segment.
Memory hook
Trigger is maternity or newborn benefits in the plan, not the market.