Appendix A: QMCSO Procedures
The following provisions constitute the Procedure for Identification and Processing of Qualified Medical Child Support Orders under the Plan:
- Alternate Recipient – shall mean any child of an employee member who is recognized under a Medical Child Support Order as having a right to enrollment under the Plan with respect to such member.
- Medical Child Support Order or Order – used interchangeably, shall mean any judgment, decree, or order, including approval of a settlement agreement, (i) that provides for child support with respect to a child of an employee member or provides for health benefit coverage to such a child, is made pursuant to a state domestic relations law, including a community property law, and relates to benefits under the Plan, or (ii) enforces a law relating to medical child support described in Section 1908 of the Social Security Act (as added by the Omnibus Budget Reconciliation Act of 1993) with respect to the Plan, if such judgment, decree or order is issued (I) by a court of competent jurisdiction, or (II) through an administrative process established under state law and has the force and effect of law under applicable state law. "Medical Child Support Order" or "Order" shall also include an administrative notice issued pursuant to an administrative process described in subclause (II) above and which has the effect of an order described in clause (i) or (ii) above.
- National Medical Support Notice – shall mean the uniform medical support notice promulgated pursuant to section 401(b) of the Child Support Performance and Incentive Act of 1998, which is set forth in the Appendix to DOL Regulation Section 2590.609-2.
- Qualified Medical Child Support Order – shall mean a Medical Child Support Order that meets all of the requirements specified in this Procedure, and that creates or recognizes the existence of the right of an Alternate Recipient to receive, or assigns to an Alternate Recipient the right to receive, benefits for which a member is eligible under the Plan. An appropriately completed National Medical Support Notice which meets the requirements described in the "Status of Order" section of this Procedure shall be deemed a Qualified Medical Child Support Order. The determination of the status of a Medical Child Support Order shall at all times be made in accordance with the provisions of any applicable regulations or other guidance issued by the Secretary of Labor or the Secretary of the Treasury. The determination by the Plan Administrator or its designee of the qualified status of a Medical Child Support Order shall be final and binding on all persons.
Status of Order
The Plan Administrator or its designee shall recognize the Order as a Qualified Medical Child Support Order if the Order clearly satisfies all of the following requirements:
- The Order discloses the name and last known mailing address, if any, of the employee member and each Alternate Recipient covered by the Order, except that, to the extent provided in the Order, the name and mailing address of an official of a state or a political subdivision thereof (hereafter "governmental official") may be substituted for the mailing address of any such Alternate Recipient; provided, however, that an Order shall not fail to be a Qualified Medical Child Support Order merely because the Order does not specify the address of the employee member or an Alternate Recipient, if the Plan Administrator or its designee is otherwise aware of the address of such employee member or Alternate Recipient.
- The Order specifies a reasonable description of the type of coverage to be provided by the Plan to each Alternate Recipient, or the manner in which such type of coverage is to be determined.
- The Order identifies the period to which such Order applies.
- The Order does not require any type or form of benefits or any opinion that is not otherwise provided under the Plan except to the extent necessary to meet the requirements of a law relating to medical child support described in Section 1908 of the Social Security Act, as added by Section 13822 of the Omnibus Budget Reconciliation Act of 1993.
- Notice of Receipt and Copy of Procedure Order. Upon receipt by the Plan of any Medical Child Support Order, the Plan Administrator or its designee shall promptly notify the employee member and each Alternate Recipient that it has received such Order and the Plan Administrator or its designee shall provide the employee member and each Alternate Recipient with a copy of this Procedure.
- Notification Following Qualification Determination. Within a reasonable time after receipt by the Plan Administrator or its designee of a Medical Child Support Order, or within such time period as shall be established under any applicable regulations issued by the Secretary of Labor or the Secretary of the Treasury, the Plan Administrator or its designee shall determine whether the Order is a Qualified Medical Child Support Order and shall notify the employee member and each Alternate Recipient of such determination. If the Plan Administrator or its designee determines that an Order is not a Qualified Medical Child Support Order, such notice shall advise that Alternate Recipient that he or she may have a right to petition the issuing court to amend the Order. Notifications shall be sent to the addresses specified in the Order, or if the Order does not specify addresses, to the last known address of the employee member and the Alternate Recipient.
- National Medical Support Notice. In the case of a National Medical Support Notice that is deemed a Qualified Medical Child Support Order, the Plan Administrator or its designee shall within 40 business days after the date of the Notice: (i) notify the state agency issuing the Notice whether coverage of the child is available under the terms of the Plan and, if so, whether such child is covered under the Plan and either the effective date of the coverage or, if necessary, any steps to be taken by the custodial parent (or governmental official) to effectuate the coverage, and (ii) provide the custodial parent (or governmental official) a description of the coverage available and any forms or documents necessary to effectuate such coverage.
- Designation of Representative. The Alternate Recipient shall be permitted to designate in writing a representative for receipt of copies of notices that are sent to the Alternate Recipient with respect to a Medical Child Support Order. Such written designation shall be provided to the Plan Administrator or its designee.
- Payment for Benefits. Any payment for benefits made by the Plan pursuant to a Medical Child Support Order in reimbursement for expenses paid by an Alternate Recipient or an Alternate Recipient's custodial parent or legal guardian shall be made to the Alternate Recipient or the Alternate Recipient's custodial parent or legal guardian. Payments to a governmental official whose name and address have been substituted for the address of an Alternate Recipient shall be treated as payment of benefits to the Alternate Recipient.
Actions Taken by the Plan Administrator
If the Plan Administrator or its designee acts in accordance with Part 4 of Title I of the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), in treating a Medical Child Support Order as being (or not being) a Qualified Medical Child Support Order, then the Plan's obligation to the employee member and each Alternate Recipient shall be discharged to the extent of any payment made pursuant to such act of the Plan Administrator or its designee.
Treatment of Alternate Recipients
- A person who is an Alternate Recipient under a Qualified Medical Child Support Order shall be considered a beneficiary under the Plan for purposes of any applicable provisions of ERISA.
- A person who is an Alternate Recipient under any Medical Child Support Order shall be considered a participant under the Plan for purposes of the reporting and disclosure requirements of Part 1 of Title I of ERISA.
Modification of Procedure
This Procedure may be modified from time to time by the Plan Administrator or its designee in its discretion to conform to regulations promulgated by the Secretary of Labor or Secretary of the Treasury or any other applicable guidance thereunder.