Coverage of each newborn
infant is required under a disability insurance policy if:
1. The policy provides coverage for another
family member, in addition to the insured person, such as the insured's spouse
or a child, and
2. The policy
specifically indicates that children of the insured person are eligible for
coverage under the policy.
(b) Coverage is required under any type of
disability insurance policy as described in par. (a), including not only
policies providing hospital, surgical or medical expense benefits, but also all
other types of policies described in par. (a), including accident only and
short term policies.
benefits to be provided are those provided by the policy and payable, under the
stated conditions except for waiting periods, for children covered or eligible
for coverage under the policy.
Benefits are required from the moment of birth for covered occurrences, losses,
services or expenses which result from an injury or sickness condition,
including congenital defects and birth abnormalities of the newborn infant to
the extent that such covered occurrences, losses, services or expenses would
not have been necessary for the routine postnatal care of the newborn child in
the absence of such injury or sickness. In addition, under a policy providing
coverage for hospital confinement and/or in-hospital doctor's charges, hospital
confinement from birth continuing beyond what would otherwise be required for a
healthy baby (e.g. 5 days) as certified by the attending physician to be
medically necessary will be considered as resulting from a sickness
(e) If a disability
insurance policy provides coverage for routine examinations and immunizations,
such coverage is required for covered children from the moment of
(f) An insurer may
underwrite a newborn, applying the underwriting standards normally used with
the disability insurance policy form involved, and charge a substandard
premium, if necessary, based upon such underwriting standards and the
substandard rating plan applicable to such policy form. The insurer shall not
refuse initial coverage for the newborn if the applicable premium, if any, is
paid as required by s.
(c), Stats. Renewal coverage for a newborn
shall not be refused except under a policy which permits individual termination
of coverage and only as such policy's provisions permit.
(g) An insurer receiving an application, for
a policy as described in par. (a) providing hospital and/or medical expense
benefits, from a pregnant applicant or an applicant whose spouse is pregnant,
may not issue such a policy to exclude or limit benefits for the expected
child. Such a policy must be issued without such an exclusion or limitation, or
the application must be declined or postponed.
(h) Coverage is not required for the child
born, after termination of the mother's coverage, to a female insured under
family coverage who is provided extended coverage for pregnancy expenses
incurred in connection with the birth of such child.
(i) A disability insurance policy described
in par. (a) shall contain the substance of s.
(j) Policies issued or
renewed on or after November 8, 1975, and before May 5, 1976, shall be
administered to comply with s. 204.325, Stats., contained in . Policies issued
or renewed on or after May 5, 1976, and before June 1, 1976, shall be
administered to comply with s.
Stats., contained in . Policies issued or renewed on or after June 1, 1976,
shall be amended to comply with the requirements of s.