07-10: Newborn Mandate under Section 376.406, RSMo

To:             All Health Insurers

From:        Linda Bohrer, Director

Re:            Newborn Mandate under Section 376.406, RSMo

Date:         December 13, 2007

After reviewing an insurer's challenge to a policy filing, Department Director Ommen issued an order on October 10, 2007 interpreting section 376.406, RSMo. The plain language of this mandate requires health carriers to provide newborn coverage from the moment of birth, when an enrollee has family or dependent coverage in force at the time of birth. That section would also mandate newborn coverage from the moment of birth for any child born to the spouse of an enrollee, who elected spousal coverage, but not dependent coverage.

This ruling corrects an earlier interpretation that section 376.406, RSMo mandated newborn coverage for a mother with individual coverage if the group plan had dependent coverage available. This previous position and subsequent insurer compliance has created an expectation in the market that thirty-one days of unpaid newborn coverage is mandated from a plan offering dependent coverage, even though the enrollee has made no election for dependent or spousal coverage. The director's order revises that interpretation. Because of the significant market change which is likely to follow the director's order, all health insurers are advised to bring conspicuous attention to this change in coverage at time of enrollment.

In addition, health insurers offering group health insurance coverage are obligated to provide a special enrollment period under section 376.450, RSMo. That section provides a special enrollment period for an enrollee, the enrollee's spouse and a newborn dependent, effective from the dependent's date of birth. This special enrollment period is the period of thirty-one days from birth, as provided under section 376.406, RSMo.