State RegulationsMI specificDifficulty 2/5
A baby born in Lansing is diagnosed with a congenital heart defect shortly after delivery, before the parents have completed any enrollment change with their Michigan health plan. May the insurer deny benefits for the defect?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
M.C.L. 500.3403 requires Michigan newborn coverage from the moment of birth and expressly includes medically diagnosed congenital defects and birth abnormalities, so pending paperwork cannot support a denial. The Michigan Department of Insurance and Financial Services (DIFS) treats such denials as violations of the Michigan newborn mandate.
Why the other options are wrong
- A) Enrollment processing cannot postpone moment-of-birth coverage under M.C.L. 500.3403.
- B) No first-year congenital exclusion is permitted by the Michigan newborn mandate.
- D) The Michigan statute covers defects medically diagnosed after birth as well — the diagnosis date does not matter.
Memory hook
Congenital defects ride the moment-of-birth coverage — no paperwork gap.