376.406. Newborn child to be covered under health policies, extent of coverage--notification of birth, when, effect of--definitions. - Missouri Statutes

Newborn child to be covered under health policies, extent ofcoverage--notification of birth, when, effect of--definitions.

376.406. 1. All health benefit plans which provide coverage for afamily member of an enrollee shall, as to such family member's coverage,also provide that the health benefits applicable for children shall bepayable with respect to a newly born child of the enrollee from the momentof birth.

2. The coverage for newly born children shall consist of coverage ofinjury or sickness including the necessary care and treatment of medicallydiagnosed congenital defects and birth abnormalities.

3. If payment of a specific premium or subscription fee is requiredto provide coverage for a child, the health benefit plan may require thatnotification of birth of a newly born child and payment of the requiredpremium or fees must be furnished to the health carrier within thirty-onedays after the date of birth in order to have the coverage continue beyondsuch thirty-one-day period. If an application or other form of enrollmentis required in order to continue coverage beyond the thirty-one-day periodafter the date of birth and the enrollee has notified the health carrier ofthe birth, either orally or in writing, the health carrier shall, uponnotification, provide the enrollee with all forms and instructionsnecessary to enroll the newly born child and shall allow the enrollee anadditional ten days from the date the forms and instructions are providedin which to enroll the newly born child.

4. The requirements of this section shall apply to all health benefitplans delivered or issued for delivery in this state on or after August 28,2001.

5. For the purposes of this section, any review, renewal, extension,or continuation of any health benefit plan or of any of the terms,premiums, or subscriptions of the health benefit plan shall constitute anew delivery or issuance for delivery of the health benefit plan.

6. As used in this section, the terms "health benefit plan", "healthcarrier", and "enrollee" shall have the same meaning as defined in section376.1350.

(L. 1974 H.B. 1487 §§ 1 to 4, A.L. 1983 S.B. 333, A.L. 2001 H.B. 328 & 88)

(1990) Statute preempted by ERISA. When employer's medical plan is self-insured, it is not subject to the requirement of automatic coverage for newborn children under health insurance plans which provide coverage for family member of the insured. (Mo. App.) St. Louis Children's Hospital v. Commerce Bancshares, Inc., No. 56423, Eastern District, May 9, 1990.

(1991) Language in statute mandating coverage for newborn child borne by a family member where policy provided coverage for family member is sufficiently broad to require mandatory health insurance coverage of a newborn child borne by the insured herself. Kelly v. Pan-American Life Insurance Co., 765 F.Supp. 1406 (W.D.Mo.).