Payment of Benefits Any payment of benefits in reimbursement for Covered Expenses paid by the child, or the child’s custodial parent or legal guardian, shall be made to the child, the child’s custodial parent or legal guardian, or a state official whose name and address have been substituted for the name and address of the child.
Qualified Medical Child Support Order (QMCSO) Eligibility for Coverage Under a QMCSO If a Qualified Medical Child Support Order (QMCSO) is issued for your child, that child will be eligible for coverage as required by the order and you will not be considered a Late Entrant for Dependent Insurance. You must notify your Employer and elect coverage for that child, and yourself if you are not already enrolled, within 31 days of the QMCSO being issued. Qualified Medical Child Support Order Defined A Qualified Medical Child Support Order is a judgment, decree or order (including approval of a settlement agreement) or administrative notice, which is issued pursuant to a state domestic relations law (including a community property law), or to an administrative process, which provides for child support or provides for health benefit coverage to such child and relates to benefits under the group health plan, and satisfies all of the following: the order recognizes or creates a child’s right to receive group health benefits for which a participant or beneficiary is eligible; the order specifies your name and last known address, and the child’s name and last known address, except that the name and address of an official of a state or political subdivision may be substituted for the child’s mailing address; the order provides a description of the coverage to be provided, or the manner in which the type of coverage is to be determined; the order states the period to which it applies; and if the order is a National Medical Support Notice completed in accordance with the Child Support Performance and Incentive Act of 1998, such Notice meets the requirements above. The QMCSO may not require the health insurance policy to provide coverage for any type or form of benefit or option not otherwise provided under the policy, except that an order may require a plan to comply with State laws regarding health care coverage.
HC-FED4
10-10
Effect of Section 125 Tax Regulations on This Plan Your Employer has chosen to administer this Plan in accordance with Section 125 regulations of the Internal Revenue Code. Per this regulation, you may agree to a pretax salary reduction put toward the cost of your benefits. Otherwise, you will receive your taxable earnings as cash (salary). A. Coverage elections Per Section 125 regulations, you are generally allowed to enroll for or change coverage only before each annual benefit period. However, exceptions are allowed: if your Employer agrees, and you meet the criteria shown in the following Sections B through F and enroll for or change coverage within the time period established by your Employer. B. Change of status A change in status is defined as: change in legal marital status due to marriage, death of a spouse, divorce, annulment or legal separation; change in number of Dependents due to birth, adoption, placement for adoption, or death of a Dependent; change in employment status of Employee, spouse or Dependent due to termination or start of employment, strike, lockout, beginning or end of unpaid leave of absence, including under the Family and Medical Leave Act (FMLA), or change in worksite; changes in employment status of Employee, spouse or Dependent resulting in eligibility or ineligibility for coverage; change in residence of Employee, spouse or Dependent to a location outside of the Employer’s network service area; and changes which cause a Dependent to become eligible or ineligible for coverage.
19
myCigna.com
Made with FlippingBook HTML5