Qualified Medical Child Support Orders
Jan L. Warner & Jan Collins
Qualifed Medical Child Support Orders allow children to receive medical coverage benefits when at least one parent is a participant in an employer-sponsored group health plan if the child would not be covered under the plan because: (1) the custodial parent has not or cannot provide such coverage; (2) the custodial parent is providing coverage through state-provided Medicaid benefits; (3) the non-custodial parent has neglected or refused to enroll the child in the employer group health plan; or (4) the child is not eligible for coverage under the terms of the group health plan.
Generally, the QMCSO may not require the plan to provide any benefit or option not otherwise provided for under the plan -- except as may be necessary to meet the requirements of the law relating to medical child support described in Section 1908 of the Social Security Act which requires that the states enact laws prohibiting insurers from denying enrollment of a child for health coverage on the grounds that the child was born out of wedlock, the child is not claimed as a dependent on a parent's federal income tax return, or the child does not reside with the parent or in the insurer's service area.
The court order must contain the following information:
1. The name and last known address (if any) of the participant, and the name and mailing address of each alternate recipient covered by the order.
2. A reasonable description of the type of coverage to be provided by the plan to each alternate recipient, or the manner in which such type coverage is to be determined.
If the plan offers a choice between indemnity and HMO coverage, the order should provide which coverage is going to be provided. And if a range of HMO options is offered, the order should designate which option must be provided.
The order could provide that the child is to receive the broadest range of benefits available under the plan or the lowest cost range of "full" medical benefits, but is is unclear whether the court, the plan administrator or the custodial parent makes the choice.
The child might even be able to get better health nsurance coverage than his parent-employee if, for example, the parent has HMO coverage and the court ordered that the child have indemnity coverage.
The administrator of the parent’s plan may want the order to provide that the plan may change coverage for the child if there is a change with respect to all other plan participants so that if the employer dropped the indemnity option for all particiipants, the same would hold true for the child.
Because of the many issues involved, it is always best to designate the best available coverage, and hope that the plan administrator approves the order.
3. The period of time during the which the order applies.
Based on the Social Security Act, after being served with a QMCSO, the employer can not disenroll a child unless the employer is provided with written evidence that (a) the QMCSO is no longer in force, (b) the child is or will be enrolled in a comparable health coverage as of the effective date of the disenrollment, or (c) the employer eliminates family health coverage for all its employees.
If properly drafted, it may be that a QMCSO could allow a child to have coverage under a policy even if his or her employee-parent is no longer employed with the company. For example, if the order provides that the child is to be covered until graduation from college, the plan may be required to continue coverage even it the parent is no longer an employee during this period.
4. Specifically designate each applicable plan.
5. State that the order is not providing any type of former benefit or option not otherwise provided for by the plan except to the extent necessary to meet the requirements of state law described in Section 1908.
QMCSO’s are authorized under ERISA ("Section 609") and the Social Security Act ("Section 1908").
SAMPLE QUALIFIED MEDICAL CHILD SUPPORT ORDER
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THE COURT FINDS AS FOLLOWS:
1. Defendant, Social Security Number 222-22-2222, can be reached at the following mailing address: Defendant is employed at and has available benefits under the following Group Health Plan or Plans:
Group # , Agreement # which is administered by . This group health plan includes the following benefits: (specifically state medical, dental, vision, etc) .
2. Defendant is the father/mother of of the following children: (list full names of children, Social Security Numbers, and dates of birth).
3. Plaintiff, SSN 444-44-4444, is the custodial parent of these children and resides with them at the following residential address:
IT IS THEREFORE ORDERED THAT:
1. The children above names are found by the Court to be “Alternate Recipients” within the meaning of Section 609 of the Employment Retirement Income Security Act of 1994 (ERISA), which was added by the Omnibus Reconciliation Act of 1993.
2. As Alternate Recipients, each child shall be enrolled in the above Plan or Plans as fo the following date: and shall receive all medical, dental, vision, and other health benefits available to the Participant.
3. The children shall receive all coverage just as if they met all of the requirements of being “dependents” as defined by the Plan or Plans.
4. Any benefits to which the children may become entitled by reason of this order which are payabe in cash to either the children as Alternate Recipients or to the Defendant on behalf of the children shall be paid to the custodial parent named above.
5. Defendant shall make such elections and consent to such withholding and deductions from pay or otherwise as may be necessary to make required payments to continue the coverage required by this Order.
6. This order applies to the above Plan(s) and any other successor plan or plans and applies to each child for the time duriing which, had the child been a dependent, the child would have been eligible or could have elected coverage under the plan or plans as follows: (again list all plans).
7. This order shall does not require the Plan to provide any benefit to an Alternate Recipient that would not have been available to a dependent under the Plan.
8. The parties shall submit this order to the Plan Administrator as soon as possible for a determination of its status as a Qualfied Medical Child Support Order.
9. While this order is in effect, the Plaintiff and Defendant shall promptly notify the Plan Administrator of any change in the following:
The addresses of Plaintiff, Defendant, any legal guardian, or any child who is found to be an Alternative Recipient ;
The change in the status of any child, including the fact that the child could no longer be deemed to be an Alternate Recipient under Section 609 of ERISA; and
Any change in the custodial parent or legal guardian of an Alternate Recipient.
It is intended that this Order shall qualify as a Qualified Medical Child Support Order under Section 609 of ERISA. This Court hereby retains jurisdiction to amend this Order as might be necessary to establish or maintain its status as a Qualified Medical Child Support Order under Section 609 of ERISA.
This material was developed with experienced professionals to give you basic information which is not intended either as a substitute for advice from an attorney or as an attempt to answer all questions about situations you may encounter. Because all situations are different, because the law of each state varies, and because you may have questions that are not covered in this material, we urge you not to rely on this material as legal advice and not to make decisions without the advice of a family lawyer whom you should consult for appropriate advice about your specific legal problems. This material is sold as is, without warranty of any kind, either expressed or implied.