252E.5 - EFFECT OF ORDER ON EMPLOYER.
252E.5 EFFECT OF ORDER ON EMPLOYER.
1. When the order has been forwarded to the obligor's employer
pursuant to section 252E.4, the order is binding on the employer and
the employer's insurer to the extent that the dependent is eligible
to be enrolled in the plan under the applicable terms and conditions
of the health benefit plan and the standard enrollment guidelines of
the insurer. The employer shall allow enrollment of the dependent at
any time, notwithstanding any enrollment season restrictions. If a
provision of this section conflicts with a provision in the national
medical support notice, or in subsection 8, the provision in the
notice and subsection 8 shall apply.
2. The employer shall forward a copy of the order to the insurer
and request enrollment of the dependent in the health benefit plan.
If the obligor fails to apply to obtain coverage for the dependent,
the employer shall accept an application to enroll a dependent which
has been signed by the obligee or other legal custodian of a child or
by the department. Within sixty days of receipt of the order or
within sixty days of receipt of application, whichever is earlier,
the insurer shall determine whether the dependent is eligible for
enrollment under the plan and shall notify the employer of the
dependent's eligibility status. If more than one plan is offered by
the employer, the dependent shall be enrolled in the health benefit
plan in which the obligor is enrolled. However, if more than one
plan is offered to the obligor, the plan selected shall provide
coverage which is accessible to the dependent.
3. The employer shall withhold from the employee's compensation,
the employee's share, if any, of premiums for the health benefit plan
in an amount that does not exceed the amount specified in the
national medical support notice or order or the amount specified in
15 U.S.C. § 1673(b) and which is consistent with federal law. The
employer shall forward the amount withheld to the insurer.
4. Within thirty days of receipt of an order that requires an
obligor to enroll a dependent in a health benefit plan, the obligor's
employer shall provide the following information, as applicable,
regarding the enrollment status of the dependent to the obligor, the
obligee, or other legal custodian of the child, and the department:
a. That the dependent has been enrolled in a health benefit
plan.
b. That the dependent is not eligible for enrollment and the
reasons that the dependent is not eligible to be enrolled.
c. That the order has been forwarded to the insurer and a
determination of eligibility for enrollment has not been made.
5. If the dependent has been enrolled in a health benefit plan,
all of the following information shall be provided:
a. The name of the insurer providing the health benefit plan.
b. The dependent's effective date of coverage.
c. The health benefit plan or account number.
d. The type of health benefit plan under which the dependent
has been enrolled, including whether dental, optical, office visits,
and prescription drugs are covered services. Additionally, the
response shall include a brief description of the applicable
deductibles, coinsurance, waiting periods for preexisting medical
conditions, and other significant terms or conditions which
materially affect the coverage.
6. a. An employer shall not revoke enrollment or eliminate
coverage for a dependent unless the employer is provided with
satisfactory written evidence that one of the following conditions
exists:
(1) A court or administrative order requiring coverage in a
health benefit plan is no longer in effect.
(2) The dependent is eligible for or will be enrolled in a
comparable health benefit plan which will take effect no later than
the effective date of revocation of enrollment in the other plan.
(3) The employer has eliminated dependent health coverage for all
employees.
b. Nothing in this section requires an employer to maintain
coverage for the dependent if the premiums are no longer being paid
by the obligor because the employer no longer owes compensation to
the obligor or because the obligor's employment has been terminated
and the obligor has not elected to continue coverage.
c. If an order requiring that the obligor provide coverage
under a health benefit plan for the dependent has been forwarded to
the obligor's employer pursuant to section 252E.4, and the obligor's
employment is terminated, the employer shall provide notice to the
obligee and the department within ten days of termination of the
obligor's employment.
7. If an order requiring that the obligor provide coverage under
a health benefit plan for the dependent has been forwarded to the
obligor's employer pursuant to section 252E.4, and the employer's
health benefit plan is terminated either in its entirety or with
respect to the obligor's insurance classification, or the employer
has changed its insurer or become self-insured, the employer shall
provide notice to the obligee or other legal custodian of the child
and the department ten days prior to the termination or change in
insurer.
8. If the department issues a national medical support notice to
an employer or plan administrator, all of the following shall apply:
a. The employer and plan administrator shall comply with the
provisions in the notice.
b. The employer and the plan administrator shall treat the
notice as an application by the department for health benefit plan
coverage for the dependent to the extent such application is required
by the health benefit plan.
c. If the obligor named in the notice is not an employee of
the employer, or if a health benefit plan is not offered or available
to the employee, the employer shall notify the department, as
provided in the notice, within twenty business days after the date of
the notice.
d. If a health benefit plan is offered or available to the
employee, the employer shall send the plan administrator's portion of
the notice to each appropriate plan administrator within twenty
business days after the date of the notice.
e. Upon notification from the plan administrator that the
dependent is enrolled, the employer shall either withhold and forward
the premiums as provided in subsection 3, or shall notify the
department that the enrollment cannot be completed due to limits
established for withholding as provided in subsection 3.
f. If the plan administrator notifies the employer that the
obligor is subject to a waiting period that expires more than ninety
days from the date of receipt of the notice by the plan administrator
or that the obligor is subject to a waiting period that is measured
in a manner other than the passage of time, the employer shall notify
the plan administrator when the obligor becomes eligible to enroll in
the plan and that the notice requires enrollment in the plan of the
dependent named in the notice.
g. The plan administrator shall enroll the dependent, and if
necessary to enrollment of the dependent shall also enroll the
obligor, in the plan selected in accordance with this paragraph. All
of the following shall apply to the selection of the plan:
(1) If the obligor is enrolled in a health benefit plan that
offers dependent coverage, that plan shall be selected.
(2) If the obligor is not enrolled in a plan or is not enrolled
in a plan that offers dependent coverage, and if only one plan with
dependent coverage is offered by the employer, that plan shall be
selected.
(3) If the obligor is not enrolled in a health benefit plan or is
not enrolled in a health benefit plan that offers dependent coverage,
if more than one plan with dependent coverage is offered by the
employer, and if the notice is issued by the child support recovery
unit, all of the following shall apply:
(a) If only one of the plans is accessible to the dependent, that
plan shall be selected. If none of the plans with dependent coverage
is accessible to the dependent, the unit shall amend or terminate the
notice.
(b) If more than one of the plans is accessible to the dependent,
the plan selected shall be the plan that provides basic coverage for
which the employee's share of the premium is lowest.
(c) If more than one of the plans is accessible to the dependent
but none of the accessible plans provides basic coverage, the plan
selected shall be a plan that is accessible and for which the
employee's share of the premium is lowest.
(d) If the employee's share of the premiums is the same under all
plans described in subparagraph (b) or (c), the unit shall attempt to
consult with the obligee when selecting the plan. If the obligee
does not respond within ten days of the unit's attempt, the unit
shall select a plan which shall be the plan's default option, if any,
or the plan with the lowest deductibles and copayment requirements.
(4) If the obligor is not enrolled in a health benefit plan or is
not enrolled in a health benefit plan that offers dependent coverage,
if more than one plan with dependent coverage is offered by the
employer, and if the notice is issued by the child support
enforcement agency of another state, that agency shall select the
plan as provided in paragraph "h", subparagraph (3).
h. Within forty business days after the date of the notice,
the plan administrator shall do all of the following as directed by
the notice:
(1) Complete the appropriate portion of the notice and return the
portion to the department.
(2) If the dependent is or is to be enrolled, notify the obligor,
the obligee, and the child and furnish the obligee with necessary
information. Provide the child support recovery unit with the type
of health benefit plan under which the dependent has been enrolled,
including whether dental, optical, office visits, and prescription
drugs are covered services.
(3) If more than one health benefit plan is available to the
obligor and the obligor is not enrolled, forward plan descriptions
and documents to the department and enroll the dependent, and if
necessary the obligor, in the plan selected by the department or in
any default option if the plan administrator has not received a
selection from the department within twenty business days of the date
the plan administrator returned the national medical support notice
response to the department.
(4) If the obligor is subject to a waiting period that expires
more than ninety days from the date of receipt of the notice by the
plan administrator or if the obligor has not completed a waiting
period that is measured in a manner other than the passage of time,
notify the employer, the department, the obligor, and the obligee.
Upon satisfaction of the period or requirement, complete the
enrollment.
(5) Upon completion of the enrollment, notify the employer for a
determination of whether the necessary employee share of the premium
is available.
(6) If the plan administrator is subject to the federal Employee
Retirement Income Security Act, as codified in 29 U.S.C. § 1169, or
is subject to the federal Child Support Performance and Incentive Act
of 1998, Pub. L. No. 105-200, § 401, subsection (e) or (f), and the
plan administrator determines the notice does not constitute a
qualified medical child support order, complete and send the response
to the department and notify the obligor, the obligee, and the child
of the specific reason for the determination.
9. This chapter does not preclude the exchange of required
information between the department and employers or insurers through
electronic data transfer. Section History: Recent Form
90 Acts, ch 1224, §29; 94 Acts, ch 1171, §27; 2002 Acts, ch 1018,
§6, 7; 2009 Acts, ch 15, §2; 2009 Acts, ch 41, §263
Referred to in § 252E.8