Texas Health Insurance Dependent Laws

Most health care companies make provisions for coverage of dependents, which obviously includes minors but often people into young adulthood. Each state has its own laws regarding health care coverage, but individual insurance companies within the state can vary in their requirements regarding documentation to provide proof of a condition or how to request certain types of coverage. If both spouses have a plan that covers dependents, the parent whose birthday comes first in the calendar year would pay for the coverage—the second parent would take over if health care costs were to exhaust maximum benefits under the first plan. The Texas Department of Insurance oversees everything concerning health insurance matters in the state, and anyone with questions about health insurance law for dependents should contact this office.

Age of Coverage

• Any child who qualifies as a dependent under a particular group health care plan can maintain this coverage until she turns 25. The state allows for indefinite coverage for those dependents that cannot support themselves due to mental or physical disability. Depending on the insurance plan, the parent may need to submit various types of information to prove the disability.

Court-ordered Insurance Coverage

• In many instances, the court will require one parent to provide health insurance as part of a child support arrangement. Texas law requires the insurance company to provide similar coverage as it would to the parent.

HMO and Self-funded Insurance

• With the exception of emergency care or an approved referral, college students covered under their parent’s insurance plan must return to the service area of the HMO plan to receive treatment in order to receive benefits. For self-funded insurance plans—in which the company itself pays out claims—these do not have to provide dependent coverage under state law.

Newborns

• Any plan with provisions for maternity care or dependent coverage must automatically cover a newborn for the first 31 days of life. Coverage cannot be denied for congenital conditions, craniofacial deformities, illnesses, accidents or premature birth. If the insured parent wishes to continue covering the child under her plan after this time frame, she must notify the plan administrator to adjust the premium. As long as a child has had continuous coverage since birth, insurance must provide coverage to repair craniofacial deformities until the child reaches at least 18 years of age.