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Texas Insurance Code §1367.103 requires a covered health benefit plan that provides family-member coverage to cover each covered child for hearing-loss screening from birth through age 30 days and necessary diagnostic follow-up related to the screening through age 24 months.
More key points
- The statute bars a deductible and dollar limits for the required benefit, while permitting copayment and coinsurance subject to the applicable plan rules.
On this page5 sections
Texas tests a specific age-limited health-coverage mandate for children's hearing screening. Insurance Code §1367.103 addresses a health benefit plan that provides coverage for a family member of an insured or enrollee. For each covered child, the plan must cover a screening test for hearing loss from birth through the date the child is 30 days old, and necessary diagnostic follow-up care related to that screening from birth through the date the child is 24 months old.
The two age windows
| Covered service | Statutory age window |
|---|---|
| Hearing-loss screening test | Birth through the date the child is 30 days old. |
| Necessary diagnostic follow-up related to the screening | Birth through the date the child is 24 months old. |
The first window applies to the screening itself. The second is broader in time but tied to necessary diagnostic follow-up related to that screening. It should not be paraphrased as unlimited coverage for every hearing service through the child's second birthday. The law also points to Chapter 47 of the Health and Safety Code for the screening framework.
Cost sharing and dollar limits
The statutory language allows copayment and coinsurance requirements but prohibits a deductible requirement or dollar limits for the mandated benefit. The plan's evidence of coverage or policy must state the applicable limitations and requirements. When an exam question asks which form of cost sharing is permitted, keep the categories distinct: copayment and coinsurance may apply; deductible and dollar-limit restrictions are expressly limited by the statute.
Texas mandated-benefit applicability depends on the kind of coverage and current law. TDI's mandate table distinguishes individual and large-employer plans from small-group plans for state-law mandates. Self-funded ERISA plans can also follow a different regulatory framework. Do not apply a state mandate to every plan in the same way without identifying the coverage type.
How the requirement fits into the policy
The mandate applies when the relevant health benefit plan provides family-member coverage and the child is covered under the plan. It does not mean every newborn is automatically enrolled in every policy. The coverage relationship and plan documents matter. For a producer, the practical task is to explain what the policy covers, how to add an eligible child, how to locate network screening or follow-up providers, and what cost-sharing terms apply without misrepresenting the statutory protection.
A timeline example
A child receives an initial hearing screen shortly after birth. If the screen indicates that a repeat screen or diagnostic evaluation is necessary, the required follow-up provision can continue through the date the child is 24 months old, provided the care is necessary and related to the screening. The 30-day limit describes the initial screening window; it does not cut off related diagnostic follow-up on day 31.
Common exam traps
- Swapping the 30-day screening period and the 24-month follow-up period.
- Extending the mandate to every hearing service, whether or not it is related to the screening.
- Saying a deductible may apply even though §1367.103 bars a deductible requirement for this mandated benefit.
- Saying no cost sharing is allowed; the statute permits copayment and coinsurance.
- Assuming the state-law mandate applies identically to every small-group, self-funded, individual, or large-employer plan.
- Confusing a health insurer's mandated-benefit obligation with a life or health producer's licensing requirements.
For an exam response, state the screening window, the follow-up window, the relationship requirement, and the cost-sharing rule separately. Then check the plan type before concluding that a particular Texas mandate applies. TDI and the current statute should be consulted when working with an actual policy.
Common questions
How long must Texas coverage include newborn hearing screening?
The statute specifies screening from birth through the date the covered child is 30 days old.
How long can related diagnostic follow-up be covered?
Necessary diagnostic follow-up care related to the screening is covered from birth through the date the child is 24 months old, subject to the statute and applicable plan rules.
Can a Texas plan apply a deductible to this benefit?
Section 1367.103 prohibits a deductible requirement for the mandated benefit. It permits copayment and coinsurance requirements.
Does the state mandate apply to every Texas health plan?
No. Applicability depends on the plan type and governing law. TDI identifies different state-law treatment by market segment, and self-funded employer plans may be governed differently.