Health Insurance

Qualified Medical Child Support Orders (QMCSO's)


Child as Alternative Recipient

A child is entitled to health care benefits as an "alternative recipient" in a parent's policy after divorce. (and in paternity actions).  The child is both an independent plan participant and a beneficiary under the plan.  NOTE:  A QMCSO advisable when a non-custodial parent is responsible for providing health coverage, but their plan does not consider the child to be a "dependent". In addition to guaranteeing coverage for the child, the QMCSO assures that information is provided to the child, allows direct reimbursement to the custodial parent, and qualifies the child for independent rights and remedies under the insurance plan.  29 U.S.C.S. Section 609 (Law Co-op. 1997) (an amendment to the Employee Retirement Income Security Act (ERISA), 29 U.S.C.S. Section 1169 (Law Co-op. 1997)).

Type of Health Insurance Plans Covered

All ERISA group health plans.  A QMCSO may be used regardless of the number of employees as long as the definition of group health plan is met.

Elements Necessary to Qualify for Coverage

Any judgment, decree, or order (including the approval of a settlement agreement) made pursuant to a state domestic relations law and issued by a court of competent jurisdiction.  The QMCSO may be included in a separate order or included in the final judgment.  The medical child support order must specifically provide for health benefit coverage to a child of a participant in a group plan, and such order must be qualified by the group health plan.  NOTE:  A child may have COBRA rights concurrent with his or her eligibility for a QMCSO.

Notice and Election Procedures

Upon issuance of a medical child support order by the court, the order must be forwarded to the plan administrator who must promptly notify the participant and the child of receipt of the order and the plan's procedures for qualifying a medical child support order.  The plan then has a "reasonable time" to determine whether the medical child support order is qualified and to notify the participant and the child of the plan's determination.  While a QMCSO need not be exercised within any specific time frame, the child may be required to comply with enrollment period requirements.  NOTE:  To avoid potential enrollment problems, have the QMCSO ready when the enrollment period begins, even if this would require the court to issue an order prior to the final judgment of divorce.  Attorneys drafting medical child support orders are advised to work with the plan administrator and obtain a copy of the summary plan description.

Maximum Length of Coverage

The maximum length of coverage is determined by the terms of the plan.  Federal law permits a QMCSO to continue until the child has completed college if the plan allows for such coverage and the parent agrees to pay the premium. 

Covered Benefits

Federal law is unclear as to whether the child may select benefits that, although available to the employee, are not the same as those selected by the employee.  NOTE: The QMCSO should explicitly address this issue.  Likewise, the QMCSO should contain a provision addressing how the plan will remain qualified if the group health care plan makes changes within its plan.

Cost of Coverage

It is unclear under federal law whether the child shall be covered under a family premium, or covered by a single premium.  The costs of the child's coverage should be determined before the QMCSO is in place so that the court order specifically addresses who is responsible for the premium payment.



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