ERISA NOTICES
should assume all plans are covered by the Notice, and send copies of Part B of the Notice to each Plan Administrator.
enrolled, the agency will make a selection after the Notice is qualified and, if the agency does not respond within 20 business days, the child will be enrolled under the plan’s default option if there is one; and • Specifying that the period of coverage may end for the named child only when similarly situated dependents are no longer eligible for coverage under the terms of the plan, or upon the occurrence of events specified in the Notice. A Notice also requires the plan to provide to a named child only those benefits that the plan provides to any dependent of a Participant who is enrolled in the plan, and any other benefits that are necessary to meet the requirements of the State laws relating to medical child support. The following information about ERISA and other laws may be useful sources of information about obtaining health care coverage and medical care for children: Two agencies in the Department of Health and Human Services play significant roles in the provision of health care coverage to children. The Office of Child Support Enforcement is responsible for establishing standards and providing guidance for the Child Support Enforcement Program under Title IV-D of the Social Security Act. • Centers for Medicare and Medicaid Services - The Centers for Medicare and Medicaid Services administers Medicaid and the State Children’s Health Insurance Program (also known as SCHIP) and provides additional guidance under HIPAA and other recently enacted health-related laws. • National Child Support Enforcement Association - The National Child Support Enforcement Association (NCSEA) is a nonprofit membership organization comprised primarily of State and local child support enforcement agencies , • Eastern Regional Inter State Child Support Association (ERICSA) and the Western Inter State Child Support Enforcement Council (WICSEC) are child support enforcement professional organizations focusing on issues of interstate child support enforcement. Each State has a child support enforcement agency. Sometimes this agency is located in the State Attorney General’s office, but it is frequently found as part of the State’s department of social or human services. National Medical Support Notice - Notice to Withhold for Health Care Coverage, OMB No. 09700222 - This Notice is issued under section 466(a)(19) of the Social Security Act, section 609(a)(5)(C) of the Employee Retirement Income. • Security Act of 1974 (ERISA), and for State and local government and church plans, sections 401(e) and (f) of the Child Support Performance and Incentive Act of 1998. Additional Information •
The application of a waiting period (such as one requiring that a new employee must be employed for a certain amount of time or work a certain number of hours) before an employee may enroll in the group health plan does not affect the employer’s obligation to transfer Part B to the Plan Administrator(s). When transferring Part B of the Notice, the Employer retains Part A. An Employer that transfers Part B of the Notice to a Plan administrator(s) may later need to use the Employer Response after it has been notified of the qualification of the Notice and has determined that necessary employee contributions cannot be withheld from wages. [Social Security Act § 466(a)(19), 45 CFR § 303.32(c)] Obligations of the Plan A Plan Administrator who receives a National Medical Support Notice must review the Notice and determine whether it is appropriately completed. The administrator must complete the Plan Administrator Response (included with Part B of the Notice), indicating whether the Notice is a QMCSO, and return it to the State agency that issued the Notice within 40 business days after the date of the Notice. If the Plan Administrator determines that the Notice is appropriately completed, the administrator is required to treat the Notice as a QMCSO. The Plan Administrator must in that case inform the State agency that issued the Notice when coverage under the plan of the child named in the Notice will begin and must provide the custodial parent of the child (or, in some cases, a named State official) with information about the child’s coverage under the plan, such as the plan’s summary plan description, any forms or documents necessary to make claims under the plan, etc. If the Participant is not enrolled and there is more than one option available under the plan for coverage of the child, the Plan Administrator must also use the Plan Administrator Response to notify the agency of that fact, and inform them of the available options for coverage. If the agency does not then respond within 20 business days and the plan has a “default option,” the Plan Administrator may enroll the child in the default option. The Department of Labor has issued a regulation, 29 CFR 2590.609-2, that provides guidance on how administrators of group health plans must deal with Notices they receive. [ERISA § 609(a)(5)(C), 29 CFR § 2590.609-2] Additional Information An “appropriately completed” Notice satisfies the informational requirements of the QMCSO provisions by: • Providing the name and last known mailing address (if any) of the Participant and the name and mailing address of each child covered by the order; • Having the child support enforcement agency identify either the specific type of coverage or all available group health coverage; • Instructing the Plan Administrator that if a Notice does not designate either specific type(s) of coverage or all available coverage, it should assume that all are designated, and further instructing the Plan Administrator that if a group health plan has multiple options and the Participant is not
IMPORTANT NOTICE: This document contains general compliance information only and does not constitute legal advice. For advice specific to your situation, please consult your attorney or tax advisor.
Made with FlippingBook - professional solution for displaying marketing and sales documents online