Policy covering family on expense-incurred basis required to include certain coverage for insured’s newly born and adopted children and children placed with insured for adoption

1. All individual health insurance policies providing family coverage on an expense-incurred basis must as to family members' coverage provide that the health benefits applicable for children are payable with respect to: (a) A newly born child of the insured from the moment of birth; (b) An adopted child from the date the adoption becomes effective, if the child was not placed in the home before adoption; and (c) A child placed with the insured for the purpose of adoption from the moment of placement as certified by the public or private agency making the placement. The coverage of such a child ceases if the adoption proceedings are terminated as certified by the public or private agency making the placement. The policies must provide the coverage specified in subsection 3 and must not exclude premature births.

2. The policy or contract may require that notification of: (a) The birth of a newly born child; (b) The effective date of adoption of a child; or (c) The date of placement of a child for adoption, and payments of the required premium or fees, if any, must be furnished to the insurer within 31 days after the date of birth, adoption or placement for adoption in order to have the coverage continue beyond the 31-day period.

3. The coverage for newly born and adopted children and children placed for adoption consists of coverage of injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities and, within the limits of the policy, necessary transportation costs from place of birth to the nearest specialized treatment center under major medical policies, and with respect to basic policies to the extent such costs are charged by the treatment center.