28 TAC §3.3403 — what it says, and how the exam tests it

28 TAC §3.3403. (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…