252E.7 - INSURER AUTHORIZATION.
252E.7 INSURER AUTHORIZATION.
1. The entry of an order requiring a health benefit plan is
authorization for enrollment of the dependent if the dependent is
otherwise eligible to be enrolled. If the obligor fails to obtain
coverage for a dependent, the insurer shall accept the signature of
the obligee or other legal custodian of the child or of an employee
of the department on the application for enrollment of the dependent
under the health benefit plan. If the dependent is otherwise
eligible to be enrolled in the plan pursuant to the applicable terms
and conditions of the health benefit plan and the standard enrollment
guidelines of the insurer, the insurer shall allow enrollment of the
dependent at any time, notwithstanding any enrollment season
restrictions.
2. An insurer shall not deny enrollment of a child under the
health benefit plan of the obligor based on any of the following:
a. The child was born out of wedlock.
b. The child is not claimed as a dependent on the obligor's
federal income tax form.
c. The child does not reside with the obligor or in the
insurer's service area.
3. For purposes of processing claims for payment, the insurer
shall accept the signature of the obligee or other legal custodian of
the child or of an employee of the department as valid authorization
for purposes of processing any medical expense claims on behalf of
the dependent for payment or reimbursement of medical services
rendered to the dependent.
4. The insurer shall have immunity from any liability, civil or
criminal, which might otherwise be incurred or imposed for actions
taken in implementing this section including, but not limited to, the
insurer's release of any information, or the payment of any claims
for services by the insurer, or the insurer's acceptance of
applications for enrollment of the dependent and medical expense
claims for the dependent which are signed by the obligee or an
employee of the department pursuant to this section.
5. If a dependent has coverage under the health benefit plan of
and through the insurer of the obligor, the insurer shall make
payment directly to the obligee, the provider, or the department for
claims submitted by the obligee, by the provider with the obligee's
approval, or by the department.
6. Payments remitted to the obligor by the insurer for services
received by the dependent shall be recoverable by the obligee or the
department from the obligor if not properly paid by the obligor to
the provider or the obligee. Section History: Recent Form
90 Acts, ch 1224, §31; 94 Acts, ch 1171, §28