| (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.
|
