Child Support Order

[Guest Benmark]

I have a question hopefully you can answer.

We operate a qualified cafeterial welfare plan. Occasionally, we get court orders (from the DA office) telling us we have to begin covering the child of one of our employees under our health plan. What happens if the employee is not enrolled in a health plan? Are we required to enroll the child AND the employee (this is the only way a child could be covered under our plan)? In what plan? We do not have a default plan of any type.

Your perspectives and guidence would be appreciated.

Thanks

[QDROphile]

A QMCSO can require the enrollment of the employee in order to provide for the coverage of the child and can require payroll deduction to cover the cost. This is rather sensitive and the DA's office may not be particularly adept at getting the right information and preparing a good order. You should get some competent professional help.

The QMCSO probably will apply directly only to the health plan. The law allows mid-year election change under a cafeteria plan to accommodate a QMCSO, and if the cafeteria plan is the only avenue for enrollment and payment under the health plan, the cafeteria plan had better have provisions to accommodate.

[Guest mjb]

The proposed order cannot require that a benefit be provided which is not available under the terms of the plan, e.g., if employee is not eligible to participate, or the dependent would not be eligible to participte in the plan the order cannot require that dependent be covered. If the plan requires that the employee be covered under separate plans in order to enroll the dependent, the plans cannot enroll the dependent until the employee enrolls in each plan. If the employee refuses to enroll in the plans it up to the court to take action to make the employee enroll in the plans, (by holding the employee in contempt of court), not the plan since the plans need the employee's consent to enroll and pay for the costs of the plan. I dont see how a court could force an employee to enroll in a FSA plan to pay for health expenses (other than the premium) which are not covered by health ins. since the ee can be required by the ct to pay for such costs on an out of pocket basis.

[jmor99]

Many times these court orders state that the individual (employee) must provide health coverage for the child, in which case the employee must find coverage, and it doesn't necessarily mean the employer's plan. I have seen employers refuse to provide coverage in these situations until the annual open enrollment.

[Guest b2kates]

I would think for an employer to hold out an employee from participation until the next open enrollment when there is a valid QMSCO would violate HIPAAs special enrollment rules.

[Guest AMP]

If your health plan is subject to ERISA, it's required to have written procedures for handling QMCSOs (ERISA Section 609(a)(5)(B)). The plan's QMCSO procedures can specify the "default" coverage into which a child is enrolled if the parent is not currently enrolled in the plan. The procedures can also require automatic enrollment of the parent into the default coverage if the parent is eligible but not enrolled and the child can only be provided coverage if the parent is also enrolled. Finally, the procedures can require the parent to pay the required employee contribution in order for the plan to comply with the QMCSO.

Oddly enough, the HIPAA Special Enrollment Rules do not provide a special enrollment period for QMCSOs (the special enrollment period applies only if the dependent child is acquired by birth or adoption). However, the change in status rules under Code Section 125 do permit (but do not require) a cafeteria plan to automatically change an employee's election to provide coverage as required under a QMCSO.