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Qualified Medical Child Support - CAM 483

Description:
The purpose of this policy is to comply with a Federal law pertaining to Qualified Medical Child Support Order.  This law relates to the provision of child support with respect to health benefit coverage of a child of a participant under a group health plan which is made pursuant to a State domestic relations law, and enforces a law relating to medical child support described in Section 1908 of the Social Security Act (as added by Section 13822 of the Omnibus Budget Reconciliation Act of 1993) with respect to a group health plan.

Policy Statement:
A Qualified Medical Child Support Order (QMCSO) creates or recognizes the existence of an alternate recipient’s right to, or assigns to an alternate recipient the right to, receive benefits for which a participant employee is eligible under a contract.

A Medical Child Support Order means any judgment, decree or order (including approval of a settlement judgment) issued by a court of competent jurisdiction which provides a child support with respect to a child of a participant covered under a contract or provides for health benefit coverage to such a child.  The order of responsibility described below should be followed upon notification of a Qualified Medical Child Support Order:

  • Custodial parent or employee furnishes employer a copy of the QMCSO.
  • Employer notifies employee and each alternate recipient of receipt of such order and their plans (ERISA) procedures for determining whether the medical child support order is a qualified medical child support.

  •  Within a reasonable period after receipt of such order, the employer shall determine whether such order is a qualified medical child support order and notify the employee and each alternate recipient.

  • A QMCSO is qualified only if such order is issued by court of competent jurisdiction (not a magistrate) and clearly specifies:
    • the name and the last known mailing address (if any) of the participant employee and the name and mailing address of each alternate recipient covered by the order.
    • 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 of coverage is to be determined;
    • the period to which such order applies; and
    • Each plan to which such order applies. 
  • Employer must establish procedures to determine if order is qualified and to administer benefits under the qualified order.  Such procedures:
    • shall be in writing;
    • shall provide for the notification of each person specified in a medical child support order as eligible to receive benefits under the plan (at the address included in the QMCSO) of the procedures;
    • shall permit an alternate recipient to designate a representative for receipt of copies of notices that are sent to the alternate recipient with respect to a medical child support order.
  • Employee notifies employer with all pertinent information to enroll this alternate recipient on the employer’s contract.
  • The QMCSO may not require a plan to provide any type or form of benefit, or an option, not otherwise provided under this plan.
  • Employer notifies Blue Cross.
  • Blue Cross must set the alternate recipient up in a manner to receive an ID card in their name and a booklet.
  • Blue Cross must make any medically necessary benefit payments in accordance with the contractual benefits of the employee to the custodial parent or the alternate recipient eighteen or over unless the claim is assigned.
  • Employer will automatically enroll alternate recipient if employee who remains employed fails to enroll an alternate recipient after receiving notice of the QMSCO and deduct any additional premium from the employee’s paycheck.
  • Membership desk procedures should be followed whenever a QMSCO has been established.
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