MEDICAL SUPPORT

CS 490P Enforcement of Medical Insurance

01/90 Revised 04/11/16 Training Completed 12/21/15

45 CFR 303.31, and 303.32; 42 U.S.C. 652(f) and 666(a)(19); U.C.A. 31A-8-502, 31A-22-610.5, 35A-7-105(2), 62A-11-103(2), 62A-11-320(2), 326.1, 326.2, 78B-12-102(6) and (15) and 78B-14-502; R527-201

 

 

Statutory Authority

 

42 U.S.C. 652(f) states:

The Secretary shall issue regulations to require that State agencies administering the child support enforcement program under this part enforce medical support included as part of a child support order whenever health care coverage is available to the noncustodial parent at a reasonable cost. . . .

 

U.C.A. 62A-11-326.1(1) states:  

The office may issue a notice to existing and future employers or unions to enroll a dependent child in an accident and health insurance plan that is available through the dependent child's parent or legal guardian's employer or union, when the following conditions are satisfied:

(a) the parent or legal guardian is already required to obtain insurance coverage for the child by a prior court or administrative order; and

(b) the parent or legal guardian has failed to provide written proof to the office that:

(i) the child has been enrolled in an accident and health insurance plan in accordance with the court or administrative order ; or,

(ii) the coverage required by the order was not available at group rates through the employer or union 30 or more days prior to the date of the mailing of the notice to enroll.”

 

R527-201-10(2) states:  

“In Non-IV-A cases and in IV-A Medicaid cases, if an obligated parent has been ordered to maintain insurance and insurance is accessible and available at a reasonable cost, ORS/CSS shall use the NMSN to transfer notice of the insurance provision to the obligated parent's employer unless ORS/CSS is notified pursuant to Section 62A-11-326.1 that the children are already enrolled in an insurance plan in accordance with the order.”

 

Office of Recovery Services/Child Support Services (ORS/CSS) issues a National Medical Support Notice (NMSN) to employers to enroll  dependent children in available health insurance plans if the parent is required to obtain insurance by a court or administrative order and health insurance has not been obtained.   ORS/CSS will not send a NMSN if the parent provides written proof that the child has already been enrolled in a health insurance plan or provides written proof that coverage was not available through the employer 30 or more days prior to the NMSN date.

 

If the information is received from the State Directory of New Hires (SDNH), you must send a National Medical Support Notice to the employer within two business days in accordance with UCA 35A-7-105(2), 42 USC 666(a)(19) and 45 CFR 303.32, which state:

 

1.                  UCA 35A-7-105(2):

“Beginning May 1, 1998, within two business days after information described in Section 35A-7-104 is entered into the registry, matched, and reported to the Office of Recovery Services, the Office of Recovery Services shall transmit a notice to the employer directing the employer to withhold the employee's wages in an amount equal to the employee's monthly or other periodic support obligation.”

 

2.                  42 USC 666(a)(19):

“. . . . all child support orders enforced pursuant to this part which shall include a provision for medical support for the child to be provided by either or both parents, and shall be enforced, where appropriate, through the use of the National Medical Support Notice promulgated pursuant to section 401(b) of the Child Support Performance and Incentive Act of 1998 . . .”

 

3.                   45 CFR 303.32:

(a) Mandatory State laws. States must have laws, in accordance with section 466(a)(19) of the Act, requiring procedures specified under paragraph (c) of this section for the use, where appropriate, of the National Medical Support Notice (NMSN), to enforce the provision of health care coverage for children of noncustodial parents and, at State option, custodial parents who are required to provide health care coverage through an employment-related group health plan pursuant to a child support order and for whom the employer is known to the State agency.

(b) Exception. States are not required to use the NMSN in cases with court or administrative orders that stipulate alternative health care coverage to employer-based coverage.

(c) Mandatory procedures. The State must have in effect and use procedures under which:

(1) The State agency must use the NMSN to transfer notice of the provision for health care coverage of the child(ren) to employers.

(2) The State agency must transfer the NMSN to the employer within two business days after the date of entry of an employee who is an obligor in a IV-D case in the State Directory of New Hires.

(3) Employers must transfer the NMSN to the appropriate group health plan providing any such health care coverage for which the child(ren) is eligible (excluding the severable Notice to Withhold for Health Care Coverage directing the employer to withhold any mandatory employee contributions to the plan) within twenty business days after the date of the NMSN.

(4) Employers must withhold any obligation of the employee for employee contributions necessary for coverage of the child(ren) and send any amount withheld directly to the plan.

(5) Employees may contest the withholding based on a mistake of fact. If the employee contests such withholding, the employer must initiate withholding until such time as the employer receives notice that the contest is resolved.

(6) Employers must notify the State agency promptly whenever the noncustodial parent's and, at State option, custodial parent's employment is terminated in the same manner as required for income withholding cases in accordance with § 303.100(e)(1)(x) of this part.

(7) The State agency must promptly notify the employer when there is no longer a current order for medical support in effect for which the IV-D agency is responsible.

(8) The State agency, in consultation with the custodial parent, must promptly select from available plan options when the plan administrator reports that there is more than one option available under the plan.

(d) Effective date. This section is effective October 1, 2001, or, if later, the effective date of State laws described in paragraph (a) of this section. Such State laws must be effective no later than the close of the first day of the first calendar quarter that begins after the close of the first regular session of the State legislature that begins after October 1, 2001. For States with 2-year legislative sessions, each year of such session would be regarded as a separate regular session.

 

NOTE:  If you determine that health insurance is available at a reasonable cost through a source other than the parent’s employer, you may attempt to enforce the insurance as an optional procedure. 

 

 

Definitions

 

1.                   Cash Medical Support – As defined by UCA 62A-11-103(2) and 78B-12-102(6):  “an obligation to equally share all reasonable and necessary medical and dental expenses of children.” 

 

2.                   Medical Expenses – As defined by U.C.A. 78B-12-102(6), “means health and dental expenses and related insurance costs.”

 

3.                   National Medical Support Notice (NMSN):  As defined by R527-201-3 Definitions (2) –

“ . . . the federally approved form that ORS/CSS shall use, when appropriate, to notify an employer to enroll dependent children in an employment-related group health insurance plan in accordance with a child support order.”

 

The National Medical Support Notice is the federally approved version of the Notice to Enroll authorized under:

a.                   U.C.A. 326.1(1) Enrollment of child in accident and health insurance plan -- Order -- Notice, which states:

(1) The office may issue a notice to existing and future employers or unions to enroll a dependent child in an accident and health insurance plan that is available through the dependent child's parent or legal guardian's employer or union, when the following conditions are satisfied:
(a) the parent or legal guardian is already required to obtain insurance coverage for the child by a prior court or administrative order; and
(b) the parent or legal guardian has failed to provide written proof to the office that:
(i) the child has been enrolled in an accident and health insurance plan in accordance with the court or administrative order; or
(ii) the coverage required by the order was not available at group rates through the employer or union 30 or more days prior to the date of the mailing of the notice to enroll.”; and, 

b.                  R527-201-10(2) Enforcement of Obligation to Maintain Medical and dental Insurance, which states:

“In Non-IV-A cases and in IV-A Medicaid cases, if an obligated parent has been ordered to maintain employer-based medical insurance and insurance is available at a reasonable cost according to R527-201-7 through an employment-related group health plan, ORS/CSS shall use the NMSN to transfer notice of the insurance provision to the obligated parent's employer unless ORS/CSS is notified pursuant to Section 62A-11-326.1 that the children are already enrolled in an insurance plan in accordance with the order.”

 

4.                   Notice to Enroll (NTE) – A legal notice authorized under U.C.A. 326.1 and R527-201 (see #2 above for more information), and issued to employers or unions to enroll a dependent child(ren) in a group health insurance plan in accordance with a medical support order.  The NTE was a state-generated form that CSS used prior to the standardized NMSN form.

 

 

5.                   Plan Administrator – As defined by CSS for purposes of using and enforcing the NMSN:  The business agent for a group health plan (the insurer), responsible for enrolling a dependent child(ren) in a group health insurance plan(s).

 

6.                   Qualified Medical Child Support Order (QMCSO) – As defined by CSS and the NMSN for purposes of using and enforcing the NMSN:  A medical child support order issued under state law that creates or recognizes the existence of an “alternate recipients” right to receive benefits for which a participant or beneficiary is eligible under a group health plan. A QMCSO satisfies certain additional requirements contained in the Employee Retirement Income Security Act (ERISA) section 609(a). The NMSN must be considered a QMCSO as long as insurance is or will become available and it contains the following information:

a.                   The names of the participant and the child(ren);

b.                  The mailing addresses for all participants; or,

c.                   The name and address of a Substituted Official or Agency; e.g., the CP’s case information has been safeguarded.  When this occurs the Substituted Official or Agency becomes ORS/CSS with the local office address.

 

NOTE:  UCA 62A-11-326.1(4) states,A notice to enroll issued under this section may be considered a "qualified medical support order" for the purposes of enrolling a dependent child in a group accident and health insurance plan as defined in Section 609(a), Federal Employee Retirement Income Security Act of 1974.”

 

7.                   Net Out-of-Pocket Cost – As defined by CSS for purposes of calculating reasonable cost:  The total cost a non-custodial parent/custodial parent (NCP/CP) pays each month toward a group health insurance plan which includes coverage for the dependent child(ren).

 

NOTE:  If the obligated parent receives UPP, you must first deduct the amount the obligated parent receives each month from Utah’ Premium Partnership for Health Insurance (UPP) from the monthly amount the obligated parent pays for his/her insurance premium.  For more information on UPP, refer to #9 below. 

8.                   Reasonable Cost – As defined by:

a.                   45 CFR 303.31(a)(3) which states:

Cash medical support or the cost of private health insurance is considered reasonable in cost if the cost to the parent responsible for providing medical support does not exceed five percent of his or her gross income or, at State option, a reasonable alternative income-based numeric standard defined in State law, regulations or court rule having the force of law or State child support guidelines adopted in accordance with § 302.56(c) of this chapter. In applying the five percent or alternative State standard for the cost of private health insurance, the cost is the cost of adding the child(ren) to the existing coverage or the difference between self-only and family coverage.” (Emphasis added.); and,

 

b.                  R527-201-7 Reasonable Cost of Insurance Premiums:

Employment-related or other group coverage that does not exceed 5% of the obligated parent's monthly gross income is generally considered reasonable in cost. . . .”; and,

 

c.                   CSS, for purposes of calculating if an insurance premium is “reasonable in cost”:  The net out-of-pocket cost the NCP/CP is required to pay toward the monthly premium to enroll the child(ren) in a group health insurance plan is less than 5% of the NCP/CP’s gross monthly income.

EXAMPLE 1:

·                     Facts:

w     Obligated parent’s gross monthly income is $2,000.00.

w     The NCP pays $93.00 per month to enroll himself, his spouse and his child from a previous marriage. 

·                     Calculations:

w     5% of the obligated parent’s income is $100.00 ($2,000.00 X 5% = $100.00).

w     The monthly net out-of-pocket cost for the family coverage is $93.00.

·                     Result:

w     Since $93.00 is less than $100.00, the obligated parent’s insurance is considered reasonable in cost.

 

EXAMPLE 2:

·                     Facts:

w     Obligated parent’s gross monthly income is $2,000.00.

w     The NCP pays $135.00 per month to enroll himself, his spouse and his child from a previous marriage. 

·                     Calculations:

w     5% of the obligated parent’s income is $100.00 ($2,000.00 X 5% = $100.00).

w     The monthly net out-of-pocket cost for the family coverage is $135.00.

·                     Result:

 

NOTE 1:  A group health insurance plan which includes coverage for the child(ren) may be an “employee plus child(ren)” plan or a “family plan”.  The plan may include coverage for children that are not on the ORS case.

 

NOTE 2:  Senior agents should make a reasonable cost determination only if/when the obligated parent requests it through an administrative review or the CP requests it because the insurance credit exceeds 50% or more of the monthly child support amount.

 

NOTE 3:  When making a reasonable cost determination, do not deduct an anticipated insurance credit amount (i.e., the credit has not previously been requested by the parent) from the monthly premium amount for a group health insurance plan which includes coverage for the child(ren) in order to calculate net out-of-pocket cost.  

 

9.                   Utah’s Premium Partnership for Health Insurance (UPP) – A state program administered by the Department of Health that helps individuals and working families afford monthly insurance premiums.  If the person is eligible for UPP, s/he must:

a.                   First enroll in a health insurance plan through his/her employer; and,

b.                  Provide a copy of his/her paycheck (each month) to UPP to verify that health insurance premiums are being deducted. 

                                                            

                UPP reimburses the individual up to $150.00 per adult and $100.00 per child every month.  In addition, the individual may receive an additional $20.00 per child each month if they are enrolled in dental insurance.

 

If the obligated parent requests an insurance credit and s/he has enrolled in UPP, you must deduct the amount the obligated parent receives from UPP from the insurance premium amount. 

 

                EXAMPLE 1:

·                     Facts:  The NCP is requesting an insurance credit.

w     The NCP pays $350.00 per month for family insurance.  The insurance covers the NCP, his spouse, their child, and the NCP’s child on a CSS case.

w     The NCP is enrolled in UPP.  UPP pays $150.00 each month for the NCP and his spouse and $50.00 each month for their child.  The NCP receives $350.00 per month from UPP.

·                     Calculations:  $350.00 (insurance premium) - $350.00 (UPP payment) = $0.00.  There is no insurance cost to the NCP for insurance.  Therefore, the NCP is not entitled to an insurance credit. 

 

EXAMPLE 2:

·                     Facts:

w     The NCP pays $500.00 per month for family insurance.  The insurance covers the NCP, his spouse, their child, and the NCP’s child on a CSS case.

w     The NCP is enrolled in UPP.  UPP pays $150.00 each month for the NCP and his spouse and $120.00 ($100.00 for medical and $20.00 for dental) each month for their child.  The NCP receives $420.00 per month from UPP.

·                     Calculations:  $500.00 (insurance premium) - $420.00 (UPP payment) = $80.00 monthly insurance cost.  The NCP’s monthly cost for insurance is $80.00 per month.

w     There are four people covered on the insurance policy:

§     NCP;

§     Present spouse;

§     Child with present spouse; and,

§     The child on the CSS case.

w     $80.00 divided by 4 = $20.00;

w     $20.00 x 1 child (CSS case) = $20.00.

w     One half of the child(ren)’s portion (insurance credit) would be $10.00.  This is calculated as follows:  $20.00 (child’s portion of insurance) divided by 2 [or multiplied by 50% (.50)] =  $10.00.

 

 

Medical Insurance Enforcement

 

CSS must enforce union and employment-related medical insurance coverage for all IV-A recipients, Non-IV-A Medicaid recipients, and Non-IV-A applicants whenever possible.  This includes all of the cases that are referred to the Attorney General’s Office (AGO) for criminal non-support and cases where the NCP/CP  is self-employed.  If the NCP/CP is self-employed, unemployed, or may have insurance through a union, send the Insurance Warning Letter if the parent is ordered to provide insurance coverage, CSS is enforcing this obligation, all the insurance policies have been ended on ORSIS, and there is no known insurance available; e.g., no active employer records on ORSIS with insurance available for the obligated parents.  

 

EXCEPTIONS: CSS will not enforce medical insurance coverage  when the obligated parent has applied for and is approved for insurance coverage for the child(ren) through the Children’s Health Insurance Program (CHIP).  CHIP is not a Medicaid program but an alternative health insurance program for those who do not qualify for Medicaid.   


The Department of Health (DOH) administers the CHIP program and determines CHIP eligibility.  If a parent has access to health insurance coverage through an employer, but the cost to enroll the child(ren) is 5% or more of the household’s gross income, DOH will determine that the child(ren) do not have access to employment related insurance and will qualify them for CHIP.  Once DOH qualifies the child(ren) for CHIP, CSS accepts the DOH determination and will not pursue medical support enforcement from that parent until a new employer or group related insurance is or becomes available.

 

NOTE:  If the child(ren) is eligible to receive medical care through Indian Health Services treat the case as you would a CHIP case.  Also see the related question and answer at the end of this section.

 

If the other parent (not receiving CHIP):

 

1.                   Is not obligated to provide coverage, determine if the medical portion of the order should be modified and refer the case on ORSIS to the modification team, if appropriate; or,

 

2.                   Is obligated but employment-related insurance is not available at a reasonable cost, write a case narrative to document the insurance coverage; or,

 

3.                   Has coverage available but it would not be accessible to the child(ren) (primarily out-of-state).  Write a case narrative to document the insurance coverage.

 

 

Timeframe – Enforcement

 

If appropriate, you must manually send:

 

1.                   An NMSN to the NCP/CP’s employer within two business days of gathering and receiving new employment information from the SDNH.  If the information is received from a source other than SDNH, you must send an NMSN within 30 days of identifying insurance is available.

 

2.                   An Insurance Warning Letter to the obligate party within 30 days when appropriate. 

 

 

Enforcement Option – National Medical Support Notice (NMSN)

 


An NMSN issued by CSS is considered to be a qualified medical child support order (QMCSO) for the purpose of enrolling a dependent child in an insurance plan. 

 

Utah State law found at U.C.A. 62A-11-326.1(1) states:

“The office may issue a notice to existing and future employers or unions to enroll a dependent child in an accident and health insurance plan that is available through the dependent child's parent or legal guardian's employer or union, when the following conditions are satisfied:

(a) the parent or legal guardian is already required to obtain insurance coverage for the child by a prior court or administrative order; and

(b) the parent or legal guardian has failed to provide written proof to the office that:

(i) the child has been enrolled in an accident and health insurance plan in accordance with the court or administrative order; or

(ii) the coverage required by the order was not available at group rates through the employer or union 30 or more days prior to the date of the mailing of the notice to enroll.”


 

NOTE:  The obligated party may only use this defense one-time (not providing CSS with written proof).  For example, the first time a NMSN (INEA/INEB) is sent to his/her employer after the order is taken.

 

Utah State law found at U.C.A. 78B-14-502 allows a NMSN to be sent to an out-of-state employer.

 

78B-14-502.   Employer's compliance with income withholding of another state.

(1) Upon receipt of an income-withholding order, the obligor's employer shall immediately provide a copy of the order to the obligor.

(2) The employer shall treat an income-withholding order issued in another state which appears regular on its face as if it had been issued by a tribunal of this state.

(3) Except as otherwise provided in Subsection (4) and Section 78B-14-503, the employer shall withhold and distribute the funds as directed in the withholding order by complying with terms of the order which specify:

(a) the duration and amount of periodic payments of current child-support, stated as a sum certain;

(b) the person designated to receive payments and the address to which the payments are to be forwarded;

(c) medical support, whether in the form of periodic cash payment, stated as a sum certain, or ordering the obligor to provide health insurance coverage for the child under a policy available through the obligor's employment;

(d) the amount of periodic payments of fees and costs for a support-enforcement agency, the issuing tribunal, and the obligee's attorney, stated as sums certain; and

(e) the amount of periodic payments of arrearages and interest on arrearages, stated as sums certain.

(4) An employer shall comply with the law of the state of the obligor's principal place of employment for withholding from income with respect to:

(a) the employer's fee for processing an income withholding order;

(b) the maximum amount permitted to be withheld from the obligor's income; and

(c) the times within which the employer must implement the withholding order and forward the child-support payment.”

 

In accordance with U.C.A. 31A-8-502, the employer may not refuse to enroll the child(ren) because they live outside of the service area.  However, the child(ren) are subject to the out-of-service area contract terms of the insurance policy.

 

31A-8-502.   Court ordered coverage for minor children who reside outside the service area.

(1) (a) The requirements of Subsection (2) apply to a health maintenance organization if the health maintenance organization plan:

(i) restricts coverage for nonemergency services to services provided by contracted providers within the organization's service area; and

(ii) does not offer a benefit that permits members the option of obtaining covered services from a non-contracted provider.

(b) The requirements of Subsection (2) do not apply to a health maintenance organization if:

(i) the child that is the subject of a court or administrative support order is over the age of 18 and is no longer enrolled in high school; or

(ii) a parent's employer offers the parent a choice to select health insurance coverage that is not a health maintenance organization plan either at the time of the court or administrative support order, or at a subsequent open enrollment period. This exemption from Subsection (2) applies even if the parent ultimately chooses the health maintenance organization plan.

(2) If a parent is required by a court or administrative support order to provide health insurance coverage for a child who resides outside of a health maintenance organization's service area, the health maintenance organization shall:

(a) comply with the provisions of Section 31A-22-610.5;

(b) allow the enrollee parent to enroll the child on the organization plan;

(c) pay for otherwise covered health care services rendered to the child outside of the service area by a noncontracted provider:

(i) if the child, noncustodial parent, or custodial parent has complied with prior authorization or utilization review otherwise required by the organization; and

(ii) in an amount equal to the dollar amount the organization pays under a noncapitated arrangement for comparable services to a contracting provider in the same class of health care providers as the provider who rendered the services; and

(d) make payments on claims submitted in accordance with Subsection (2)(c) directly to the provider, custodial parent, the child who obtained benefits, or state Medicaid agency.

(3) (a) The parents of the child who is the subject of the court or administrative support order are responsible for any charges billed by the provider in excess of those paid by the organization.

(b) This section does not affect any court or administrative order regarding the responsibilities between the parents to pay any medical expenses not covered by accident and health insurance or a health maintenance organization plan.

(4) The commissioner shall adopt rules as necessary to administer this section and Section 31A-22-610.5.”

 

“31A-22-610.5.   Dependent coverage.

(1) As used in this section, "child" has the same meaning as defined in Section 78B-12-102.

(2) (a) Any individual or group accident and health insurance policy or health maintenance organization contract that provides coverage for a policyholder's or certificate holder's dependent may not terminate coverage of an unmarried dependent by reason of the dependent's age before the dependent's 26th birthday and shall, upon application, provide coverage for all unmarried dependents up to age 26.

(b) The cost of coverage for unmarried dependents 19 to 26 years of age shall be included in the premium on the same basis as other dependent coverage.

(c) This section does not prohibit the employer from requiring the employee to pay all or part of the cost of coverage for unmarried dependents.

(d) An individual health insurance policy, group health insurance policy, or health maintenance organization shall continue in force coverage for a dependent through the last day of the month in which the dependent ceases to be a dependent:

(i) if premiums are paid; and

(ii) notwithstanding Section 31A-8-402.3, 31A-8-402.5, 31A-22-721, 31A-30-107.1, or 31A-30-107.3.

(3) An individual or group accident and health insurance policy or health maintenance organization contract shall reinstate dependent coverage, and for purposes of all exclusions and limitations, shall treat the dependent as if the coverage had been in force since it was terminated; if:

(a) the dependent has not reached the age of 26 by July 1, 1995;

(b) the dependent had coverage prior to July 1, 1994;

(c) prior to July 1, 1994, the dependent's coverage was terminated solely due to the age of the dependent; and

(d) the policy has not been terminated since the dependent's coverage was terminated.

(4) (a) When a parent is required by a court or administrative order to provide health insurance coverage for a child, an accident and health insurer may not deny enrollment of a child under the accident and health insurance plan of the child's parent on the grounds the child:

(i) was born out of wedlock and is entitled to coverage under Subsection (5);

(ii) was born out of wedlock and the custodial parent seeks enrollment for the child under the custodial parent's policy;

(iii) is not claimed as a dependent on the parent's federal tax return; or

(iv) does not reside with the parent or in the insurer's service area.

(b) A child enrolled as required under Subsection (4)(a)(iv) is subject to the terms of the accident and health insurance plan contract pertaining to services received outside of an insurer's service area. A health maintenance organization shall comply with Section 31A-8-502.

(5) When a child has accident and health coverage through an insurer of a noncustodial parent, and when requested by the noncustodial or custodial parent, the insurer shall:

(a) provide information to the custodial parent as necessary for the child to obtain benefits through that coverage, but the insurer or employer, or the agents or employees of either of them, are not civilly or criminally liable for providing information in compliance with this Subsection (5)(a), whether the information is provided pursuant to a verbal or written request;

(b) permit the custodial parent or the service provider, with the custodial parent's approval, to submit claims for covered services without the approval of the noncustodial parent; and

(c) make payments on claims submitted in accordance with Subsection (5)(b) directly to the custodial parent, the child who obtained benefits, the provider, or the state Medicaid agency.

(6) When a parent is required by a court or administrative order to provide health coverage for a child, and the parent is eligible for family health coverage, the insurer shall:

(a) permit the parent to enroll, under the family coverage, a child who is otherwise eligible for the coverage without regard to an enrollment season restrictions;

(b) if the parent is enrolled but fails to make application to obtain coverage for the child, enroll the child under family coverage upon application of the child's other parent, the state agency administering the Medicaid program, or the state agency administering 42 U.S.C. Sec. 651 through 669, the child support enforcement program; and

(c) (i) when the child is covered by an individual policy, not disenroll or eliminate coverage of the child unless the insurer is provided satisfactory written evidence that:

(A) the court or administrative order is no longer in effect; or

(B) the child is or will be enrolled in comparable accident and health coverage through another insurer which will take effect not later than the effective date of disenrollment; or

(ii) when the child is covered by a group policy, not disenroll or eliminate coverage of the child unless the employer is provided with satisfactory written evidence, which evidence is also provided to the insurer, that Subsection (9)(c)(i), (ii) or (iii) has happened.

(7) An insurer may not impose requirements on a state agency that has been assigned the rights of an individual eligible for medical assistance under Medicaid and covered for accident and health benefits from the insurer that are different from requirements applicable to an agent or assignee of any other individual so covered.

(8) Insurers may not reduce their coverage of pediatric vaccines below the benefit level in effect on May 1, 1993.

(9) When a parent is required by a court or administrative order to provide health coverage, which is available through an employer doing business in this state, the employer shall:

(a) permit the parent to enroll under family coverage any child who is otherwise eligible for coverage without regard to any enrollment season restrictions;

(b) if the parent is enrolled but fails to make application to obtain coverage of the child, enroll the child under family coverage upon application by the child's other parent, by the state agency administering the Medicaid program, or the state agency administering 42 U.S.C. Sec. 651 through 669, the child support enforcement program;

(c) not disenroll or eliminate coverage of the child unless the employer is provided satisfactory written evidence that:

(i) the court order is no longer in effect;

(ii) the child is or will be enrolled in comparable coverage which will take effect no later than the effective date of disenrollment; or

(iii) the employer has eliminated family health coverage for all of its employees; and

(d) withhold from the employee's compensation the employee's share, if any, of premiums for health coverage and to pay this amount to the insurer.

(10) An order issued under Section 62A-11-326.1 may be considered a "qualified medical support order" for the purpose of enrolling a dependent child in a group accident and health insurance plan as defined in Section 609(a), Federal Employee Retirement Income Security Act of 1974.

(11) This section does not affect any insurer's ability to require as a precondition of any child being covered under any policy of insurance that:

(a) the parent continues to be eligible for coverage;

(b) the child shall be identified to the insurer with adequate information to comply with this section; and

(c) the premium shall be paid when due.

(12) The provisions of this section apply to employee welfare benefit plans as defined in Section 26-19-2.

(13) The commissioner shall adopt rules interpreting and implementing this section with regard to out-of-area court ordered dependent coverage.”

 

However, if the employer fails to honor the NMSN, send an interstate referral to the state and request enforcement. 

 

If the NMSN is sent to a NCP/CP’s employer and the employer challenges the NMSN on the grounds that the administrative order does not specify dental coverage should be provided, instruct the employer to only enforce the medical provision.  Refer the case to the appropriate team for a modification of the order to include a current medical provision, which orders medical and dental coverage. Manually generate and send a new NMSN to the employer after the order has been amended.  Utah Judicial orders, per U.C.A. 78B-12-102(15) are not affected.

 

NOTE:  If the CP contacts CSS and indicates that s/he did not receive this information from the Plan Administrator, send the “National Medical Support Notice Reminder to the Plan Administrator.”  This letter reminds the Plan Administrator to provide the CP with a description of the available coverage, the effective date of the coverage, a summary plan description, and any forms, documents, or information necessary to effectuate such coverage, as well as information necessary to submit claims for benefits.

 

 

Failure to Enroll – Procedures

 

Sixty days after the National Medical Support Notice was sent to the employer, the agent assigned to the case receives an alert.  If the employer/plan administrator fails to provide the insurance information or respond in any way, complete the following:

 

1.                   Generate the Failure to Enroll form.  This form notifies the employer that the NMSN sent to them previously by CSS:

a.                   Is authorized under state law found at U.C.A. 62A-11-326.1 and 326.2;

b.                  That they are responsible to enroll the dependent child(ren) in an insurance plan; or,

c.                   The office will be required to take additional action.  The employer is given five additional days to provide enrollment information for the child(ren) to prevent further action.

 

2.                   Make a copy of the response to the form and send it to the Central Imaging Unit (CIU) to be imaged and maintained in Content Manager for the case.

 

3.                   Mail the original form to the employer.

 

4.                   Write a detailed case narrative documenting all actions taken on the case.

 

5.                   Monitor the case for a response.  If no response is received within the 15 days, send a referral packet to the appropriate Attorney General’s Office (AGO).

 

 

Medical Support Only Order

 

If there is an order for medical support only (no child support ordered), the case must be monitored for medical enforcement and any appropriate actions taken within the designated time frames while the case is also going through any necessary order establishment actions.

 

 

Intergovernmental

 

If you are enforcing an order and the CP is required to provide insurance, but the case is an active outgoing interstate – CSENet case, you must send a free form narrative to the other state informing them that the order requires the CP to provide insurance, not the NCP.  When ORSIS sends the medical insurance information through CSENet, CSENet only indicates that insurance is ordered, not the party.   

 

NOTE:  If the other state has not received a hard copy of the order, follow-up by sending a copy of the order.

 

If the NCP/CP’s current insurance coverage is geographically limited because the child(ren) (all of the child(ren)) resides outside of the service area and the child(ren) would realize little or no benefit by continuing to require the employer to enroll the child(ren) in an insurance plan, terminate the NMSN.

 

 

Changes in Insurance Coverage

 

The sections below apply to all Utah orders, regardless of the date it was issued.

 

1.                   Lapsed Insurance:  If the parent that is providing insurance no longer has insurance available and there was an insurance credit, adjust the current support debt back to the full amount without seeking a modification of the order.  Retroactively adjust the current child support arrears to the full child support amount for the months the parent obligated to provide insurance did not pay the premium.

 

2.                   Premium Increases:  If there is a specific insurance credit amount included in the order and the amount of the premium increases, ORS is bound by the terms of the order in accordance with State law.  If the NCP and/or CP feel like the terms of the order are no longer valid or unfair, s/he may pursue the matter in court.  CSS does not have the authority to modify the terms of the order. 

 

3.                   Premium Decreases:  If there is a specific insurance credit amount included in the order and the amount of the premium decreases, ORS is bound by the terms of the order in accordance with State law.  If the NCP and/or CP feel like the terms of the order are no longer valid or unfair, s/he may pursue the matter in court.  CSS does not have the authority to modify the terms of the order. 

 

4.                   Notification:  Notify both parents in writing of changes to the child support award by generating and sending the "Insurance Premium Credit Notification" letters. 

                                                                                                                               

 

Procedures - Terminating the National Medical Support Notice

 

R527-201-9(10) which states:

“ORS/CSS shall promptly notify the employer when a current order for medical support is no longer in effect for which ORS/CSS is responsible.”

 

1.                   If the medical support order is no longer in effect or the NCP/CP successfully contests the NMSN:

a.                   Send the Insurance:  Notice to Terminate form to the employer notifying them that the NMSN is terminated (Option 1);

b.                  Send a copy of the form to the parent providing the insurance; and,

c.                   Make a case narrative indicating why the form was sent.

 

2.                   If ORS is closing the case and the NCP/CP has no other cases with ORS but there still exists a valid order with medical support language:

a.                   Send the Insurance:  Notice to Terminate form to the employer notifying them that ORS is no longer involved in the enforcement of the NMSN (Option 2);

b.                  Send a copy of the form to the parent providing insurance; and,

c.                   Make a case narrative indicating why the form was sent.