Request By:
Mr. Sheldon L. Freilich
Administrative Management Specialist
St. Joseph Infirmary
Post Office Box 17264
Eastern Parkway at Preston
Louisville, Kentucky 40217
Opinion
Opinion By: Robert F. Stephens, Attorney General; By: Joseph R. Johnson, Assistant Attorney General
This letter is in response to your request for an opinion of this office regarding the question of whether an insurance company selling health insurance policies in Kentucky must include neonatal health coverage as part of its policy benefits.
There are two (2) statutory provisions which were enacted by the 1976 session of the General Assembly. KRS 304.17-042 concerns coverage for newly born children from moment of birth in individual health policies and KRS 304.18-032 concerns such coverage in group or blanket health policies.
KRS 304.17-042 states that any health insurance policy which provides family coverage on an expense incurred basis must also provide coverage for an insured's newly born child from the moment of birth. The coverage for the newly born child must provide benefits for the care and treatment of medically diagnosed congenital defects and birth abnormalities. If the insurance company requires that an extra premium be paid for such neonatal coverage, the company must be notified of the child's birth within thirty-one (31) days after its birth in order for such coverage to continue beyond the thirty-one (31) day period.
KRS 304.18-032 contains the identical provisions regarding neonatal coverage as KRS 304.17-042. Both individual and group or blanket health insurance policies which provide family coverage must also provide coverage for newly born children for at least thirty-one (31) days after its birth.
However, it should be noted that both these provisions are only applicable to health insurance policies delivered in this state on or after October 1, 1976.