QMCSO for nephew

[Guest Philip2]

Our employee has custody of his nephew. We have received a national notice ordering us to provide health insurance to the nephew. The employee has custody of the nephew but not guardianship, nor has he adopted the nephew. The state is saying that because a court ordered the employee to provide coverage, we have to comply and enroll the nephew. Doesn't a QMCSO have to be for a "child" of the participant?

[Guest chloe]

Under the federal law, they cannot require a plan to enroll someone who is not otherwise eligible under the plan. So, if your plan does not cover these situations (and most wouldn't), then you would not be required to enroll the nephew. The order is for the employee to obtain coverage for the child. If the child cannot be enrolled in the group plan, the employee would have to obtain individual coverage for the child.

Of course, there could be different requirements in state law if your plan is insured.