Medical Child Support Orders

April 13, 2006

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A Qualified Medical Child Support Order (QMCSO) is a legal document from a court of law ordering you to include a child or children as dependents under your employee's coverage. The situation most typically arises in a divorce case where one of the parties succeeds in having the court order the other party to provide health insurance for the children.

When you receive an order, the first thing you should do is contact the health plan administrator and notify them of the order. Many states have passed laws that also require employers to comply with QMCSOs. Generally, these laws state that when a parent is required by a court or administrative order to provide health coverage that is available through an employer, the employer must permit the parent to enroll the child in family health coverage without regard to enrollment season restrictions.

If the parent fails to enroll the child, the other parent or the state child support agency can make the enrollment. The child cannot be disenrolled unless the employer is provided with satisfactory written evidence that the court order is no longer in effect or the child is or will be enrolled in comparable coverage on the effective date of the disenrollment, or unless the employer has eliminated family health coverage for all employees. The employer must deduct any health insurance premiums from the employee's earnings and pay the premiums to the insurer.

You should work out with your administrator how you will handle a QMCSO if you get one. Among the issues you need to discuss are:

What do you do with children covered by a QMCSO if the employee quits?
If the children are beneficiaries, what rights do they have under COBRA?
What happens when a dependent child reaches majority and is no longer eligible?
Must the child elect the same coverage as his or her parent or does the child have the right to select different benefits?
Does a QMCSO supersede any preexisting clauses or other exclusions in your policy so that you have to cover the child no matter the health condition?