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QMCSO vs Consent Order


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We have an employee who is being required by the court to cover his 2 dependent children on our health plan. The employee reached out to inquire why the update was not done. I told him we have yet to receive the QMCSO from the state. The employee provided the signed Consent Order from the court that details the requirement to add the 2 children. He and his attorney think that the Civil Action Order produced by the court for the child support agency did not include a provision to add the children, just the removal of his child support payment; which could be why a QMCSO was never sent. The coverage effective date was 4/1/19 according to the Consent Order and the employee lives in NJ.

Thoughts on next steps? Ok to use the Consent Order or should I tell the employee he needs to get a QMCSO generated and sent? I read through the H&W SPD and it doesn't appear that the Consent Order would qualify, but just wanted to get guidance elsewhere.

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DOL/EBSA booklet:  https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/publications/qualified-medical-child-support-orders.pdf

Don't forget the administrator's responsibility to determine if the order is qualified.

 

I'm a retirement actuary. Nothing about my comments is intended or should be construed as investment, tax, legal or accounting advice. Occasionally, but not all the time, it might be reasonable to interpret my comments as actuarial or consulting advice.

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Forget about the court order and enrollment timing for a moment. Is the employee eligible to enroll the children under the plan and has the employee requested enrollment?

QMCSOs and other orders are usually a bypass of the deadbeat employee.  If the employee is requesting the coverage, those direct legal compulsions may be superfluous. There may be a role for them as an exception to the plan’s rules relating to timing of enrollment.

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Yes, the plan permits enrolling dependents. The employee reached out to me in mid-May to inquire as to why the children were not enrolled. This is when I told him we were unaware of any Court Order.

I did just put through the enrollment for the children, retro back to 4/1/19. While not a QMCSO, the Court Order had all other relevant information, including the employee's name/signature, the children's names and DOB's, the date they should be covered, and which plans to enroll them in. I took this as being qualified based off the information from the booklet david rigby provided.

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