QMCSO...no family coverage available to employee, required to cover ch

[Guest erisa15]

Employer has an insured group health plan. Employer pays 80% for individual coverage. It used to allow employees to choose family coverage and pay the difference but it no longer provides for this option. There are a few employees who have family coverage because they had it before the employer changed its policy.

Employee A has individual coverage and has notified employer that he maybe required to provide health insurance for his children. If the Plan gets a QMCSO are they required to allow the employee to elect family coverage?

Section 609 of ERISA does provide that a medical support order is a QMCSO if "such order does not require a plan to provide any type or form of benefit, or any other option, not otherwise provided under the plan, except to the extent necessary to meet the requirements of a law relating to medical child suport described in section 1908 of the Social Security Act...."

Any thoughts?

[papogi]

If the plan no longer has any provisions to cover anyone beyond the employee, then the QMCSO has no jurisdiction to force the plan to offer family coverage. The employee may simply have to go out and purchase an individual policy for the child.

[QDROphile]

Perhaps someone would like to comment on the language of ERISA section 609(a)(2) (A) (i), which says that the order may "create ... an alternate recipient's right to, or [assign] the alternate recipient the right to, receive benefits for which a participant is eligible ... .

This has all sorts of implications, such as the alternate recipient could be substituted for the employee/participant if dependent coverage is not available, or perhaps that the alternate recipient gets the reimbursement money instead of the participant.

I don't believe that the statute means what is says (if you can figure out what it says). I also believe that another section trumps the stupid language, but isn't it nice to be working from a comprehensible concept?