3.2 QUALIFIED MEDICAL CHILD SUPPORT ORDERS
The Plan will enroll children of an Eligible Employee or Retired Participant, as directed by a Qualified Medical Child Support Order (QMCSO). A Qualified Medical Child Support Order is any judgment, decree or order issued by a court or by an administrative agency under applicable state law that has the force of state law which:
- provides the child of an Eligible Employee or Retired Participant with coverage under a health benefits plan, or
- enforces a state law relating to medical child support pursuant to Section 1908 of the Social Security Act, which provides in part that if the Eligible Employee or Retired Participant parent does not enroll the child, then the non-Employee or -Participant parent or State agency may enroll the child.
To be Qualified, a Medical Child Support Order must clearly specify:
- the name and last known mailing address of the Participant and the name and mailing address of each child covered by the Order,
- a description of the type of coverage to be provided by the Plan to each such child,
- the period to which the Order applies.
An appropriately completed National Medical Support Notice that satisfies the above requirements will be deemed a Qualified Medical Child Support Order.
A Medical Child Support Order will not qualify if it would require the Plan to provide any type or form of benefit or any option not otherwise provided under this Plan, except to the extent necessary to comply with Section 1908 of the Social Security Act.
Payment of benefits by the Plan under a Medical Child Support Order to reimburse expenses claimed by a child shall be made to the child or his custodial parent or legal guardian if so required by the Medical Child Support Order.
No Participant’s child covered by a Qualified Medical Child Support Order will be denied enrollment on the grounds that the child is not claimed as a Dependent on the parent’s Federal income tax return or does not reside with the parent.
When a Qualified Medical Child Support Order is Received
The Trustees have adopted a Qualified Medical Child Support Order Procedure, which is available upon request and without charge from the Trust Customer Service Office. If the Trust receives a proposed or final order, the Trust Customer Service Office will notify the Participant and each child named in the order. The order will then be reviewed to determine if it meets the definition of a “Qualified Medical Child Support Order.” Within a reasonable time, the Participant and each child named in the order will be notified of the decision. A notice will also be sent to each attorney or other representative named in the order or accompanying correspondence.
If the order is not qualified, the notice will give the specific reason for the decision. The party(ies) filing the order will be given an opportunity to correct the order or appeal the decision through the Claims Review Process explained in this Booklet. If the order is qualified, the notice will give instructions for enrolling each child named in the order. A copy of the entire Qualified Medical Child Support Order must be received prior to enrollment, and Retired Participants must pre-pay the required contributions for the child(ren). Child(ren) enrolled pursuant to a Qualified Medical Child Support Order will be subject to all provisions applicable to Dependent coverage under the Plan.