QUALIFIED MEDICAL CHILD SUPPORT ORDERS
The Company provides medical, dental and vision coverage to employees’ dependent children as long as they meet the eligibility requirements of the plans. In accordance with federal law, the Company also provides medical, dental and vision coverage to certain dependent children (called alternate recipients) if the Company is directed to do so by a Qualified Medical Child Support Order (QMCSO).
Under this law, courts or authorized state agencies may require an employee, in certain events such as a divorce, to provide medical, dental and vision coverage to a child who might not otherwise be covered. In addition to requiring the employee to provide coverage for the child, the law authorizes the Company to take the applicable payroll deduction.
A QMCSO is a “medical child support order” that is “qualified” under the OBRA ‘93 requirements.
A medical child support order:
Is any decree, judgment, or order (including approval of settlement agreement) from a state court with jurisdiction over the child’s support or a state agency of competent jurisdiction
Recognizes the child as an alternate recipient for plan benefits
Provides, based on a state domestic relations law (including a community property law), for the child’s support or health plan coverage
Specifically refers to the plan which will provide coverage.
A medical child support order is qualified if it specifies:
The employee’s name and last known address
Each alternate recipient’s name and address
A reasonable description of the coverage the alternate recipient is entitled to
The coverage effective date
How long the child is entitled to coverage
Each plan subject to the order.
When the Company receives a medical child support order, it will promptly notify both the employee and the alternate recipient that the order has been received and what procedures the Plan will use to determine if the order is qualified. Within a reasonable period, the Company will decide, based on the Plan’s written procedures whether it is qualified. Once the decision is made, the Company will notify the employee and alternate recipient by mail.
If the medical child support order is a QMCSO, the Company will notify the employee and each alternate recipient specified in the QMCSO of the Plan’s procedures, and allow the alternate recipient an opportunity to designate a representative to receive copies of any notices due under the QMCSO.
Coverage for the alternate recipient will commence on the date specified in the QMCSO. This is not necessarily the first day of a calendar month.
The employee is allowed to make a new health care coverage election if necessary to accommodate a QMCSO.
If a dependent contribution is required, specific authorization from the employee is not required for the payroll deduction to be established. Any applicable payroll deduction will be retroactive to the alternate recipient’s effective date.
The Plan pays the provider if the claim is assigned. Otherwise, the Plan usually pays the employee. However, when a covered expense has been paid by an alternate recipient, custodial parent or legal guardian, the Plan will reimburse the person who paid the expense.
If the medical child support order is not a QMCSO, the Company will notify the participant and each alternate recipient within a reasonable period of the specific reasons that the medical child support order does not qualify as a QMCSO and the procedures for submitting a corrected medical child support order.
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