Qualified Medical Child Support Orders and non-enrolled parents

[Mary C]

Our plan states that children can only be enrolled in same HMO option as parent. However, very often the custodial parent and children live in a different state/HMO service area than the parent-employee. In these cases, some of our HMO's will enroll the children without covering the employee-parent, and some won't. Does anyone know if the parent lives in a different service area whether an HMO in the child's area MUST enroll the child or not? What experiences have you had regarding this?

[jeanine]

I think the simplest thing to do would be to change your plan language so that the "child in the same HMO area" provision does not apply to children who are covered under a QMCSO. If you have the option of enrolling them under dependent coverage only, fine. However, I believe the clarification issued earlier this year allowed you to enroll the employee (against their wishes) in a plan if that is what it took to get the child covered.

[Mary C]

Thanks, Jeannine. I knew we could enroll the parent against their wishes, but what I have a problem with is that we require the employee to pay 50% of the premium for coverage. If the parent is enrolled in a New York HMO and the child lives in Florida, I don't think we should need to enroll the parent in the Florida HMO too just to get the child enrolled. In addition, I think this would violate the plan since it states you can only be covered by it once. I guess I was hoping that the government would require the HMO's to enroll the child even without the parent enrolled.