QMCSO

[Chaz]

Can an plan administrators' QMCSO procedures provide that a QMCSO will not be honored if the QMCSO is not submitted to the plan administrator within 31 days of the date of the order?

[J Simmons]

25 USC §1169(a)(5)(B) requires "Each group health plan shall establish reasonable procedures to determine whether medical child support orders are qualified medical child support orders and to administer the provision of benefits under such qualified orders." Nothing more definite than that regarding your issue.

I don't know that the 31 day requirement would qualify as reasonable. You might want to get a legal opinion before trying to impose that 31 day requirement. Generally, it would be better from a claims and cost management and business operations perspectives to know who you are covering and collect the premium from the employee than to have a court second guess you and order coverage you had denied.

[QDROphile]

What does 31 days have to do with whether or not a MCSO qualifies? There is nothing date sensitive about the timing of the orders, so how can the plan impose some time requirement? The plan can choose give effect to the order prospectively, so delay between the date the order is issued and the date of receipt by the plan can affect the timing of coverage, but not the application of the order.

[Guest lbwilliams2018]

Can an plan administrators' QMCSO procedures provide that a QMCSO will not be honored if the QMCSO is not submitted to the plan administrator within 31 days of the date of the order?

No. QMCSOs are written to generically apply to any employer/plan administrator so as to be used should the employee change jobs and without having to return to court to reword the order for a specific employer/plan administrator. Therefore, QMCSOs can potentially be given to current and future employers/plan administrators well beyond 31 days of the order's issue date.

A plan administrator cannot deny a QMCSO because the order is more than 31 days old when an ordered parent changes jobs 5 years after the order was issued and submits a 5 year old order to the new plan administrator.

It is also not allowed to set a limit to require submission of the QMCSO within 31 days of the parent becoming eligible, say in the case of a new hire, or even within 31 days of open enrollment for current employees.

[karen1027]

I am a custodial parent of three children. A QMCSO has been in effect since 1998 whereby I am suppose to receive payment, i.e. reimbursement, checks and EOB's. My ex has changed health insurance carriers several times. The health insurance company he currently has is refusing to accept the court order from me. They indicate it must come from his employer. Can the health insurance company refuse to accept it from me?

[QDROphile]

The plan administrator is responsible for implementing the terms of a QMCSO. The health insurer is directed by the plan administrator in the same way that the plan administrator directs a health insurer to enroll participants and benefitciaries. In the real world for many employers the health insurer covers or assists with the administrative responsibilities, so the health insurer may be playing cute, but probably has no duty to pay attention to you. The plan administrator has the duty. The plan administrator is probably the employer.

[karen1027]

Thank you. This hasn't happened previously - there has been at least 8 health insurance companies since 1998. I do recall one from years ago telling me it had to be renewed every year but that never happened. When I was first advised by the insurance company that it had to come from the employer, I contacted the employer and was assured that they (the employer) had sent it in, the health insurance company had it and that it was in effect. Ex is now getting the checks and is withholding reimbursement for those checks from me. He is not cashing the checks but he is not giving me credit either for the total amount of the check.

There also is wording in the QMCSO regarding the level of coverage. The plan my ex is now covered under causes me to have a much higher out of pocket than previously. Also it has an extremely high deductible and coinsurance. I(my share of the payment) am now subsidizing his family's deductible and coinsurance. One of my children takes a medication that costs over $4400 every three months under this plan (was much less under a different carrier). It results in me having an out of pocket over $1100 (I can't afford that.). He has the option to purchase a different plan at work which has better coverage with less out of pocket expense.

The insurance company has a form the employer fills out - they do not want the actual Order. It lists the children's name, my name and questions whether or not it is a "full QMCSO". What exactly is a "full QMCSO"? The other option on this form is to get a health insurance card directly from the health insurance company. Kids always got cards directly from their father.

How can the insurance company ignore a Court Order?

[Guest lbwilliams2018]

Thank you. This hasn't happened previously - there has been at least 8 health insurance companies since 1998. I do recall one from years ago telling me it had to be renewed every year but that never happened. When I was first advised by the insurance company that it had to come from the employer, I contacted the employer and was assured that they (the employer) had sent it in, the health insurance company had it and that it was in effect. Ex is now getting the checks and is withholding reimbursement for those checks from me. He is not cashing the checks but he is not giving me credit either for the total amount of the check.

There also is wording in the QMCSO regarding the level of coverage. The plan my ex is now covered under causes me to have a much higher out of pocket than previously. Also it has an extremely high deductible and coinsurance. I(my share of the payment) am now subsidizing his family's deductible and coinsurance. One of my children takes a medication that costs over $4400 every three months under this plan (was much less under a different carrier). It results in me having an out of pocket over $1100 (I can't afford that.). He has the option to purchase a different plan at work which has better coverage with less out of pocket expense.

The insurance company has a form the employer fills out - they do not want the actual Order. It lists the children's name, my name and questions whether or not it is a "full QMCSO". What exactly is a "full QMCSO"? The other option on this form is to get a health insurance card directly from the health insurance company. Kids always got cards directly from their father.

How can the insurance company ignore a Court Order?

Hi Karen,

What are the circumstances for the reimbursements from the insurance company? Typically reimbursements from the insurance company are rare. Does your order obligate dad to reimburse you for out of pocket expenses?

[Guest andrearlov61]

I agree. I also can't find anything about reimbursement in any article in this site. I just hope it's possible. I would also like to know if there's a toll free number where we could talk to someone about this?

[karen1027]

I agree. I also can't find anything about reimbursement in any article in this site. I just hope it's possible. I would also like to know if there's a toll free number where we could talk to someone about this?

Are you looking for reimbursement directly from the insurance company?

[karen1027]

You need a Court Order to get reimbursement.

I agree. I also can't find anything about reimbursement in any article in this site. I just hope it's possible. I would also like to know if there's a toll free number where we could talk to someone about this?