Plan Administrator

National Medical Support Notice

Employers forward the National Medical Support Notice to the plan administrator of a group health plan maintained by the employer (or a group health plan to which the employer contributes) and in which the identified participant (employee) is enrolled or is eligible for enrollment.

A National Medical Support Notice informs you that the named participant is obligated by an order issued by the court or agency to provide health care coverage for the child (children) under the group health plan(s) as described in Part B - Medical Support Notice to the Plan Administrator.

(A) If the participant and child and their mailing addresses (or that of a Substituted Official or Agency) are identified (in the Notice*), and if coverage for the child is or will become available, this Notice constitutes a "qualified medical child support order" (QMCSO) under the Employee Retirement Income Security Act (ERISA) or the Child Support Performance and Incentive Act (CSPIA), as applicable. You must, within 40 business days of the date of the Notice, or sooner if reasonable:

(1) Complete Part B - Plan Administrator Response - and send it to the Issuing Agency:

(a) if you checked Response 2:

(i) notify the noncustodial parent/participant named above, each named child, and the custodial parent that coverage of the child(ren) is or will become available (notification of the custodial parent will be deemed notification of the child(ren) if they reside at the same address);

(ii) furnish the custodial parent a description of the coverage available and the effective date of the coverage, including, if not already provided, a summary plan description and any forms, documents, or information necessary to effectuate such coverage, as well as information necessary to submit claims for benefits;

(b) if you checked Response 3:

(i) if you have not already done so, provide to the Issuing Agency copies of applicable summary plan descriptions or other documents that describe available coverage including the additional participant contribution necessary to obtain coverage for the child(ren) under each option and whether there is a limited service area for any option;

(ii) if the plan has a default option, you are to enroll the child(ren) in the default option if you have not received an election from the Issuing Agency within 20 business days of the date you returned the Response. If the plan does not have a default option, you are to enroll the child(ren) in the option selected by the Issuing Agency.

(c) if the participant is subject to a waiting period that expires more than 90 days from the date of receipt of this Notice, or has not completed a waiting period whose duration is determined by a measure other than the passage of time (for example, the completion of a certain number of hours worked), complete Response 4 on the Plan Administrator Response and return to the employer and the Issuing Agency, and notify the participant and the custodial parent; and upon satisfaction of the period or requirement, complete enrollment under Response 2 or 3, and

(d) upon completion of the enrollment, transfer the applicable information on Part B Plan Administrator Response to the employer for a determination that the necessary employee contributions are available. Inform the employer that the enrollment is pursuant to a National Medical Support Notice.

(B) If within 40 business days of the date of this Notice, or sooner if reasonable, you determine that this Notice does not constitute a QMCSO, you must complete Response 5 of Part B - Plan Administrator Response and send it to the Issuing Agency, and inform the noncustodial parent/participant, custodial parent, and child(ren) of the specific reasons for your determination.

(C) Any required notification of the custodial parent, child(ren) and/or participant may be satisfied by sending the party a copy of the Plan Administrator Response, if appropriate. You may choose to furnish these notifications electronically in accordance with the requirements of the Department of Labor’s electronic disclosure regulation codified at 29 C.F.R. 2520.104b-1(c).

* If a mailing address is not present, but it is reasonably accessible, the Notice will not fail to be a QMCSO on that basis.

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