QMCSOs and NMSMs

What is a QMCSO?

Under section 609(a) of ERISA, every group health plan must provide benefits in accordance with the applicable requirements of any qualified medical child support order ("QMCSO"). A QMCSO is a medical child support order issued under State law that creates or recognizes the existence of an alternate recipient's right to receive benefits for which a participant or beneficiary is eligible under a group health plan, and which satisfies certain additional requirements contained in ERISA Section 609(a). Section 514(b)(7) of ERISA also provides that ERISA preemption of State laws does not apply to QMCSOs. All U.S. companies that provide health care coverage to their employees must comply with the provisions of a Qualified Medical Child Support Order (QMCSO) issued by a state court regarding the provision of health care coverage for the children of their employees/noncustodial parents.

What is a National Medical Support Notice?

In order to expedite the approval of qualified medical child support orders by plan administrators, the federal government issued final rules that provide for a National Medical Support Notice that can be utilized by state agencies for the purpose of enforcing the federal QMCSO provisions. The National Medical Support Notice has two parts, Part A (the Notice to Withhold for Health Care Coverage) and Part B (the Medical Support Notice to Plan Administrator). Part A is submitted by the issuing agency (ie: the IV-D agency or child support enforcement agency) to the employer of the custodial parent who is required by a state domestic relations order to provide health care coverage to his/her child.

Critical Timing and Notice Requirements Imposed by ERISA

When it comes to QMCSOs and National Medical Support Notices, there are sensitive timing and notice requirements for the employer and plan administrator. For example, if the employer determines that family health coverage is available for the alternate recipients listed in Part A of the National Medical Support Notice, the employer is required to:

Unlawful Refusal to Enroll

With respect to the submission of a National Medical Support Notice, enrollment of a child may not be denied on the ground that: (1) the child was born out of wedlock; (2) the child is not claimed as a dependent on the participant's Federal income tax return; (3) the child does not reside with the participant or in the plan's service area; or (4) because the child is receiving benefits or is eligible to receive benefits under the State Medicaid plan. If the plan requires that the participant be enrolled in order for the child(ren) to be enrolled, and the participant is not currently enrolled, the plan administrator must enroll both the participant and the child(ren). All enrollments are to be made without regard to open season restrictions.

Effective Date of the National Medical Support Notice

Section 401(c) of the Child Support Performance and Incentive Act (CSPIA) amended section 466(a)(19) of the Social Security Act (contained in part D of Title IV of the SSA) to require states to enact laws requiring the use of the National Medical Support Notice. This requirement is effective for each state on or after the later of October 1, 2001, or the effective date of laws enacted by the legislature of such state implementing the amendments to the SSA made by section 401 of the CSPIA, but in no event later than the first day of the first calendar quarter beginning after the close of the first regular session of the state legislature that begins after October 1, 2001. In the case of a state that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the state legislature. Some states therefore, may not have laws mandating the use of the Notice until 2003. Until that time, such states may continue to use medical child support orders other than the Notice.

Call QDRO Consultants Today!

We encourage you to call us toll-free at (800) 527-8481 to find out how we can help your company establish and maintain its ERISA compliance in the area of QMCSOs and National Medical Support Notices.