500.3403 Health insurance policy offering dependent coverage; required provisions; denial prohibited; grounds.
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500.3403 Health insurance policy offering dependent coverage; required provisions; denial prohibited; grounds.
Sec. 3403.
(1)An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that makes dependent coverage available under the health insurance policy shall do all of the following:
(a)Make available dependent coverage, at the option of the policyholder, until the dependent has attained 26 years of age.
(b)Provide the same health insurance benefits to a dependent child that are available to any other covered dependent.
(c)Provide health insurance benefits to a dependent child at the same rate or premium applicable to any other covered dependent.
(d)Include both of the following provisions in the health insurance policy:
(i)That the health insurance benefits applicable for children are payable with respect to a newly born child of the insured from the moment of birth.
(ii)That the coverage for newly born children consists of coverage of injury or sickness including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities.
(2)A health insurance policy that offers dependent coverage shall not deny enrollment to an insured's child on any of the following grounds:
(a)The child was born out of wedlock.
(b)The child is not claimed as a dependent on the insured's federal income tax return.
(c)The child does not reside with the insured or in the insurer's service area.
(3)This section does not require an insurer or plan to make coverage available for a child of a child receiving dependent coverage.
History: Add. 1975, Act 20, Imd. Eff. Apr. 3, 1975 ;-- Am. 2016, Act 276 , Imd. Eff. July 1, 2016 ;-- Am. 2023, Act 158 , Eff. Feb. 13, 2024
Compiler's Notes: Section 2 of Act 20 of 1975 provides: “The requirements of this act shall apply to all insurance policies delivered or issued for delivery in this state more than 120 days after the effective date of the act.”
Popular Name: Act 218