QMCSO--Child Only?

[JWK]

Plan receives QMCSO requiring coverage of employee's child. Employee had waived coverage under plan. Can plan force employee to enroll as a condition to enrolling the child pursuant to the QMCSO? Or does the plan have to permit "child-only" enrollment?

[Guest [Pat M]]

Plan does not have to permit child-only enrollment. Where there is no cost to EE for either Parent/Child(ren) or Child-Only coverage, it's no issue anyway. However, if plan does not have Child-Only tier, plan forces Parent/Child(ren) enrollment with all applicable EE contributions.

P.S. the Medical Child Support Working Group (responsible for the new Medical Child Support Notice ) met last week, supposedly for the last time to finalize the rules printed in the 11/15 Federal Register. http://frwebgate.access.gpo.gov/cgi-bin/ge...=99-29401-filed Final should be printed soon.

[JWK]

Pat: Thanks for the response. Here there is an employee contribution for coverage and the employee is covered under new spouse's plan. Doesn't want coverage but has to cover the child from prior marriage.

Is the basis for your opinion the provision in the statute that does not require a plan to offer a type or form of benefit, or any option, not otherwise provided under the plan. So, if the plan doesn't generally offer "child only" coverage, it wouldn't have to do so for a QMCSO. Or, are you aware of other guidance besides the statute on this point?

[Guest [Pat M]]

Here's the text from proposed rules, that should be effective sometime next year. If you need help w/ caselaw lookup, let me know. Try www.law.emory.edu search.

"...It is the view of the Department that a Notice is appropriately completed, within the meaning of section 609(a)(5)©, if Part B of the Notice (i) identifies an employee of an employer, enrolled or eligible for enrollment in a group health plan sponsored by an employer or to which an employer contributes, who is a noncustodial parent obligated by a State court or administrative order to provide medical child support for one or more alternate recipients named in the Notice, and (ii) indicates the type of health care coverage to be provided to the alternate recipient(s). The Notice satisfies ERISA section 609(a)(3) by including the necessary information in Part B, by expressly requiring the plan to treat an alternate recipient as a dependent under the terms of the plan and by specifying that coverage may only end for the alternate recipient when similarly situated dependents are no longer eligible for coverage under the terms of the plan, or upon the occurrence of certain specified events. 4 (Certain other events that may lead to a loss of coverage of the alternate recipient (e.g., the death of the participant) may be "qualifying events" as specified in ERISA section 603, thereby triggering the continuation coverage (also known as COBRA) provisions of ERISA.) The Notice satisfies ERISA section 609(a)(4) because it states that the alternate recipient(s) must be provided only the coverage that the plan provides, or be enrolled in an option provided under the plan, except to the extent necessary to meet the requirements of a State law described in SSA section 1908. Accordingly, if Part B is appropriately completed as specified above, and in the Instructions, the Notice is deemed to be a QMCSO.

4 Section 1908(a)(2)© and (3)© of the SSA provide that, when a child is provided health care coverage by a parent's insurer pursuant to a court or administrative order, the child may only be disenrolled if the employer or insurer is provided satisfactory evidence that the order is no longer in effect, the child is or will be enrolled in comparable coverage which will take effect no later than the effective date of disenrollment, or the employer eliminates family health coverage for all of its employees. ......"

My take is that family coverage (Parent/Child, Parent/Children, Parent/Family) coverage is a requirement. This means the tier includes the employee.