Question re: National Medical Support Notice

[Guest VirginiaLawyer]

My client is questioning how (and whether) to comply with a NMSN. The facts: Client has a collectively bargained group health plan. The Plan provides health coverage for union employees and their dependents, as long as the dependents are truly dependents - that is, the employee has to provide more than 50% of the dependent's support. There are provisions in the Plan for making a determination that a dependent is in fact eligible for coverage under the Plan. Employees have to provide birth certificates or otherwise prove the required level of support. The problem that has arisen is with NMSN sparked by a custody battle, where the Employer (also the Plan Administrator) has received an NMSN for a child, and they have no record of the child's status as a dependent of the employee, so they don't know whether the child is truly qualified to be a participant under their Plan. The NMSN doesn't give them many options - it's pretty much deemed to be qualified as long as it identifies the participant and gives names and addresses. Of course, the NMSN can't require the Plan to provide a benefit that the Plan wouldn't otherwise provide, but how does the Plan Administrator communicate that to the court or issuing agency using the NMSN? How can they just request additional information without being seen as failing to comply with the NMSN? Does anyone have experience with these?

Thanks for any assistance, and I apologize if this question has been answered elsewhere - I didn't find it through a search.

[Guest b2kates]

See ERISA section 609

the plan should have a procedure for determining whether this is a QMSCO under the terms of the plan and the plan has a reasonable time to determine whether this is qualified.

We often contacted the issuing agency and explained that we needed additional information. Further since under your Plan it seems there is a factual support issue from the Participant; such information should be obtainable from the Participant.

If you wish to discuss, feel free to drop me a note with your number and I will give you a call.