3.3
QUALIFIED MEDICAL CHILD SUPPORT ORDERS
The Plan will enroll children of an Eligible Employee or Retired
Participant, as directed by a Qualified Medical Child Support Order
(QMCSO). A Qualified Medical Child Support Order is any judgment,
decree or order issued by a court or by an administrative agency
under applicable state law that has the force of state law which:
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provides the child of an Eligible
Employee or Retired Participant with coverage under a health benefits
plan, or
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enforces a state law relating
to medical child support pursuant to Section 1908 of the Social
Security Act, which provides in part that if the Eligible Employee
or Retired Participant parent does not enroll the child, then
the non-Employee or -Participant parent or State agency may enroll
the child.
To be Qualified, a Medical Child Support Order must clearly specify:
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the name and last known mailing address of the Participant
and the name and mailing address of each child covered by the
Order,
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a description of the type of coverage to be provided by the
Plan to each such child,
- the period to which the Order applies.
An appropriately completed National Medical Support Notice that
satisfies the above requirements will be deemed a Qualified Medical
Child Support Order.
A Medical Child Support Order will not qualify if it would require
the Plan to provide any type or form of benefit or any option
not otherwise provided under this Plan, except to the extent necessary
to comply with Section 1908 of the Social Security Act.
Payment of benefits by the Plan under a Medical Child Support
Order to reimburse expenses claimed by a child shall be made to
the child or his custodial parent or legal guardian if so required
by the Medical Child Support Order.
No Participant’s child covered by a Qualified Medical
Child Support Order will be denied enrollment on the grounds that
the child is not claimed as a Dependent on the parent’s
Federal income tax return or does not reside with the parent.
When a Qualified Medical Child Support Order is Received
The Trustees have adopted a Qualified Medical Child Support
Order Procedure, which is available upon request and without charge
from the Trust Customer Service Office. If the Trust receives
a proposed or final order, the Trust Customer Service Office will
notify the Participant and each child named in the order. The
order will then be reviewed to determine if it meets the definition
of a “Qualified Medical Child Support Order.” Within
a reasonable time, the Participant and each child named in the
order will be notified of the decision. A notice will also be
sent to each attorney or other representative named in the order
or accompanying correspondence.
If the order is not qualified, the notice will give the
specific reason for the decision. The party(ies) filing the order
will be given an opportunity to correct the order or appeal the
decision through the Claims Review Procedures and Complaint Procedures explained in this Booklet. If the order is qualified, the
notice will give instructions for enrolling each child named in
the order. A copy of the entire Qualified Medical Child Support
Order must be received prior to enrollment, and Retired Participants
must pre-pay the required contributions for the child(ren). Child(ren)
enrolled pursuant to a Qualified Medical Child Support Order will
be subject to all provisions applicable to Dependent coverage under
the Plan.
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