Babies born to Texans in state-regulated health plans will now be covered for their first 60 days, up from 31. Under the new rules from the Texas Department of Insurance, parents will get until the 60th day to add a child and pay any added premium.
For HMOs, the department’s adoption order, published in the Oct. 9 Texas Register, expands required newborn coverage “from 31 days to 60 days following birth” and extends the deadline to notify the HMO. For small and large employer plans, the order says SB 896 moves the end of the mandatory coverage period from the 32nd day to the 61st day after birth. It moves the deadline for an enrollee to notify the plan and pay any additional premium from the 31st day to the 60th day. The department filed both orders with the secretary of state Sept. 21.
For a new family, that is an extra month to add a baby to a plan. The order treats the coverage period and the notice-and-payment deadline as a pair, and both move.
The department received written comments from two organizations, the Texas Medical Association and the Texas Hospital Association. Both supported the rules with changes. One comment asked the department for guidance on two recent cases in which coverage is being denied for newborns whose mothers are listed as dependents on their own parents’ health plans. The department did not change the rule. It responded that concerns about a violation of insurance law can be reported through the complaint process on its website.
The same order set carries other 2025 laws. HMO contracts with pharmacies must follow the state’s pharmacy-benefit contracting standards under SB 1236, and HMOs may not engage in conduct that violates the state’s pharmacist-disclosure protections under SB 493. Contracted doctors must keep records of a patient’s other health coverage, tied to the standard coordination-of-benefits questionnaire in HB 388, and vision plans must follow new contracting rules under HB 3211.
A fifth change drew the only real dispute. Under SB 926, an HMO that encourages an enrollee to use a particular doctor or provider must act only “for the primary benefit of the enrollee or contract holder,” the fiduciary duty the final rule cites. The medical and hospital groups objected to a sentence in the proposal saying the department would judge violations “based on an assessment of the HMO’s conduct,” saying it implied broad discretion. They also asked the department to restate the statute’s examples and add enforcement language. The department deleted the sentence but declined the rest. It said the Insurance Code already gives it broad enforcement authority and that its “form review checklists reflect SB 926.”
The rules do not touch premiums. Prior Dispatch analysis found Texans paying more to insure nearly everything. Parents of babies born on or after Oct. 11 who run into a denial can file a complaint with the department.