Section 376.406

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 2001   

  376.406.  Newborn child to be covered under health policies, extent of coverage — notification of birth, when, effect of — definitions. — 1.  All health benefit plans which provide coverage for a family member of an enrollee shall, as to such family member's coverage, also provide that the health benefits applicable for children shall be payable with respect to a newly born child of the enrollee from the moment of birth.

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

  3.  If payment of a specific premium or subscription fee is required to provide coverage for a child, the health benefit plan may require that notification of birth of a newly born child and payment of the required premium or fees must be furnished to the health carrier within thirty-one days after the date of birth in order to have the coverage continue beyond such thirty-one-day period.  If an application or other form of enrollment is required in order to continue coverage beyond the thirty-one-day period after the date of birth and the enrollee has notified the health carrier of the birth, either orally or in writing, the health carrier shall, upon notification, provide the enrollee with all forms and instructions necessary to enroll the newly born child and shall allow the enrollee an additional ten days from the date the forms and instructions are provided in which to enroll the newly born child.

  4.  The requirements of this section shall apply to all health benefit plans 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 a new delivery or issuance for delivery of the health benefit plan.

  6.  As used in this section, the terms "health benefit plan", "health carrier", and "enrollee" shall have the same meaning as defined in section 376.1350.

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(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.).