A 1993 amendment to the Employee Retirement Income Security Act (ERISA)
requires employment-based group health plans to extend health care coverage to
the children of a parent-employee who is divorced, separated, or never married
when ordered to do so by state authorities. This compliance assistance guide
explains these ERISA provisions and describes how a plan can be required to cover a
Generally, a State court or agency may require an ERISA-covered health plan
to provide health benefits coverage to children by issuing a medical child
support order. The group health plan must determine whether the medical child
support order is “qualified.” Such an order is referred to as a Qualified
Medical Child Support Order (QMCSO). In addition, a State child support
enforcement agency may obtain group health coverage for a child by issuing a
National Medical Support Notice that the group health plan determines to be
Group health plan sponsors and administrators will find this information
useful in understanding the rights and obligations of those involved in child
support proceedings and those responsible for administering group health plans.(1)
The first section of this Compliance Assistance Guide … Qualified Medical Child
Support Orders provides general questions and answers about Qualified Medical
Child Support Orders. The second section answers questions about National
Medical Support Notices and the role of State child support enforcement agencies
in obtaining health care coverage on behalf of children. A final resource
section lists additional resources that may provide useful information about
ERISA and obtaining health care coverage and medical care for children.
This section includes an overview of the ERISA provisions that require group
health plans to extend health care coverage to children of eligible participants
and beneficiaries, plus general information about the requirements that apply to
a Qualified Medical Child Support Order (QMCSO). Questions addressed in this section:
What is a QMCSO?
Who can be covered by a QMCSO?
What information is required for a medical child support order to be qualified?
Who determines whether a medical child support order is qualified?
What types of health plans are required to recognize QMCSOs?
The QMCSO provisions apply to “group health plans” subject to the
Employee Retirement Income Security Act of 1974, as amended (ERISA). For this
purpose a “group health plan” generally is a plan that both:
Is sponsored by an employer or employee organization (or both)
and provides “medical care” to employees, former employees, or their
“Medical care” means amounts paid for the diagnosis, cure, mitigation,
treatment or prevention of a disease; for the purpose of affecting any
structure or function of the body; transportation primarily for or essential to
such care or services; or for insurance covering such care or services.
ERISA does not generally apply to plans maintained by: Federal, State or local
governments; churches; and employers solely for purposes of complying with
applicable workers compensation or disability laws. However, provisions of the Child Support
Performance and Incentive Act (CSPIA) of 1998 require church plans to comply
with QMCSOs and National Medical Support Notices, and State and local government
plans to comply with National Medical Support Notices.
[ERISA §§ 4(b), 609(a), and 607(1), Internal Revenue Code § 213(d), CSPIA § 401(f)]
A “QMCSO” is a medical child support order that:
Creates or recognizes the right of an alternate recipient to receive
benefits for which a participant or beneficiary is eligible under a group health
plan or assigns to an alternate recipient the right of a participant or
beneficiary to receive benefits under a group health plan; and
Is recognized by the group health plan as “qualified” because it includes
information and meets other requirements of the QMCSO provisions. (see Qs 1–6
In addition, a properly completed National Medical Support Notice (see
Section 2) must be treated as a QMCSO.
[ERISA § 609(a)(2), 609(a)(5)(C)]
A medical child support order is a judgment, decree, or order (including an
approval of a property settlement) that:
Is made pursuant to State domestic relations law (including a community
property law) or certain other State laws relating to medical child support (see
Provides for child support or health benefit coverage for a child of a
participant under a group health plan and relates to benefits under the plan.
[ERISA § 609(a)(2), Social Security Act § 1908]
No. Any judgment, decree, or order that is issued by a court of competent
jurisdiction or an administrative agency authorized to issue child support
orders under State law (such as a State child support enforcement agency) that
provides for medical support of a child is a medical child support order.
[ERISA § 609(a)(2)]
Any child of a participant in a group health plan who is recognized under a
medical child support order as having a right to enrollment under the plan with
respect to such participant is an alternate recipient.
[ERISA § 609(a)(2)]
A medical child support order must contain the following information in order
to be qualified:
The name and last known mailing address of the participant and each alternate
recipient. The order may substitute the name and mailing address of
a State or local official for the mailing address of any alternate recipient;
A reasonable description of the type of health coverage to be provided to
each alternate recipient (or the manner in which such coverage is to be
determined) ; and
The period to which the order applies.
[ERISA § 609(a)(3)]
An order may not require a plan to provide any type or form of benefit, or
any option, not otherwise provided under the plan, except to the extent
necessary to meet the requirements of certain State laws described in Q1-8
[ERISA § 609(a)(4)]
At the time that the QMCSO provisions were added to ERISA, Congress also
added section 1908 to the Social Security Act. Section 1908 says that States
cannot receive Federal Medicaid funds unless they have in place specific State
laws relating to medical child support. States must have laws that:
Require health insurers to enroll a child under his or her parent’s health
insurance even if the child was born out of wedlock, does not reside with the
insured parent or in the insurer’s service area, or is not claimed as a
dependent on the parent’s Federal income tax return;
Require a health insurer to enroll a child pursuant to court or
administrative order without regard to the plan’s open season restrictions;
Require employers and insurers to comply with court or administrative orders
requiring the parent to provide health coverage for a child; and
Require insurers to permit a custodial parent to file claims on behalf of his
or her child under the non-custodial parent’s health insurance and to make
benefit payments to the custodial parent or health care provider.
[ERISA § 609(a)(2),609(a)(4), Social Security Act §1908]
If a QMCSO refers to these State laws or requires a plan to comply with the
substantive requirements contained in the State laws, the plan must comply with
them. For instance, a QMCSO may require a plan to enroll a child before the plan’s
next open enrollment period.
[ERISA § 609(a)(2), 609(a)(4)]
The administrator of the group health plan is required to determine whether
an order is qualified. The administrator is required to make this determination
within a reasonable period of time pursuant to reasonable written procedures
that have been adopted by the plan. The administrator must first notify the
participant and the alternate recipient when the plan receives a
medical child support order and must give them copies of the plan’s procedures
for determining whether it is qualified. The administrator must notify
those parties of its determination whether or not the order is qualified.
[ERISA § 609(a)(5)]
Plan administrators must determine whether a medical child support order is
qualified within a reasonable period of time after receiving the order. What is
a reasonable period will depend on the circumstances. For example, an order that
is clear and complete when submitted should require less time to review than one
that is incomplete or unclear. The National Medical Support Notice provisions
contain separate, specific time limits on the processing of the Notice by
employers and plan administrators (see Qs 2-3 and 2-4).
[ERISA § 609(a)(5)]
Yes. An employee who is eligible to enroll is a participant in the plan and
thus the order is a medical child support order.
[ERISA §§ 3(7), 609(a)(1)]
The plan administrator must determine if the order is qualified and, if so,
provide coverage to the child. If the employee is eligible to participate in the
plan, the child must be covered. If, as a condition for covering his dependents,
the employee must be enrolled, the plan must enroll both.
Yes. An employee who has not yet satisfied a plan’s generally
applicable waiting period (such as requiring that the person be employed for
a certain number of days or work a certain number of hours before being
eligible for benefits) is also a participant in the plan, and the order is a
medical child support order.
[ERISA §§ 3(7), 609(a)(1)]
The plan administrator must determine if the order is qualified. If the order
is qualified, the administrator should have procedures in place so that the
child will begin receiving benefits upon the employee’s satisfaction of the
waiting period. (See Q2-7)
No. As stated in Q1-7, a medical child support order is not qualified
if it requires a plan to provide a type or form of benefit or option not
otherwise available under the plan. An order may not require a plan to provide
dependent coverage when that option is not otherwise available under the plan.
[ERISA § 609(a)(4)]
No. A plan administrator generally is not required to determine whether the
issuing court or agency had jurisdiction to issue an order, whether State law is
correctly applied in an order, whether service was properly made on the parties,
or whether an individual identified in an order as an alternate recipient is in
fact a child of the participant.
No. In many cases, an order that is submitted to the plan may clearly
describe the identity and rights of the parties, but may be incomplete only with
respect to factual identifying information within the plan administrator’s
knowledge or easily obtained through a simple communication with the alternate
recipient’s custodial parent, the participant, or the State child support
enforcement agency. For example, an order may misstate the names of the
participant or alternate recipients, and the plan administrator can clearly
determine the correct names, or an order may omit the addresses of the
participant or alternate recipients, and the plan administrator’s records
include this information. In such a case, the plan administrator should
supplement the order with the appropriate identifying information, rather than
rejecting the order as not qualified.
The order need only provide a coverage description that enables the plan
administrator to determine which of the available options and levels of coverage
should be provided to the child. For instance, if an order requires that a child
be provided any coverage available under the plan, the plan administrator would
determine the coverage available under the plan (e.g., major medical,
hospitalization, dental) and provide that coverage to the alternate recipient.
However, if the plan offers more than one type of coverage (e.g., an HMO and a
fee-for-service option), the order should make clear which should be provided or
how the choice is to be made. If the order is unclear, the plan’s procedures
may direct the administrator to contact the submitting party, or may provide
other selection methods similar to those established for the processing of
National Medical Support Notices (see Q2-4). If the plan does not have such procedures, the
administrator may have to reject the order.
No. As stated in Q1-7, a medical child support order is not qualified
if it requires a plan to provide a type or form of benefit that is not otherwise
available under the plan. Requiring a plan that provides benefits solely through
a limited-area HMO to provide benefits to alternate recipients outside of the
HMO’s service area (i.e., on a fee-for-service or any other basis), would be
requiring the plan to provide a form of benefit that the plan does not
ordinarily provide. On the other hand, if the child is able to come into the HMO’s
service area for medical care, the plan would be required to provide benefits to
the alternate recipient.
[ERISA § 609(a)(4)]
Nothing in Title I of ERISA would prohibit the plan from providing such
coverage pursuant to the terms of any medical child support order, regardless of
whether the order satisfies the qualification requirements of section 609(a),
provided that the terms of the plan do not otherwise prohibit coverage of the
child for any other reasons, such as the child does not reside with the
participant, or is not claimed as a dependent on the participant’s Federal
income tax return.
Yes. A child covered by a group health plan pursuant to a QMCSO is a
beneficiary under the plan. The Internal Revenue Service (which has jurisdiction
over such questions related to continuation coverage) has informed the Department that a child covered pursuant
to a QMCSO is therefore a “qualified beneficiary” with the right to elect
continuation coverage under COBRA, if the plan is subject to COBRA and if the
child loses coverage as a result of a qualifying event.
[ERISA §§ 609(a)(7)(A) and 607(3)]
It is the view of the Department that following a determination that an order
is qualified, the alternate recipient (and the participant, if necessary) must
be enrolled as of the earliest possible date following such determination. For
example, if an insured plan only adds new participants or beneficiaries as of
the first day of each month, that plan would be required to provide coverage to
the alternate recipient as of the first day of the first month following the
determination that the order is qualified. As described in Q’s 1-8 and 1-9,
the State laws described in section 1908 of the Social Security Act require that
when a child is enrolled in a plan pursuant to a court or administrative order,
that enrollment be made without regard to open season restrictions.
[Social Security Act § 1908]
It is the view of the Department that Congress intended custodial parents
and/or State child support enforcement agencies acting on the child’s behalf
to have access to plan and participant benefit information sufficient to prepare
a QMCSO. Information important for that purpose would include the summary plan
description, relevant plan documents, and a description of any particular
coverage options, if any, that have been selected by the participant.
The Department believes that Congress did not intend to require parties
seeking coverage of a child to first submit a medical child support order to the
plan in order to establish rights to information in connection with a child
support proceeding. However, a plan administrator may condition disclosure of
such information on receiving information sufficient to reasonably establish
that the disclosure request is being made in connection with a child support
proceeding. A disclosure request from a State child support enforcement agency
should be assumed to be made in connection with a child support proceeding.
The plan administrator must act in accordance with the provisions of the
QMCSO as if it were part of the plan. In particular, any payment for benefits in
reimbursement for expenses paid by an alternate recipient or an alternate
recipient’s custodial parent or legal guardian must be made to the alternate
recipient, custodial parent, or legal guardian.
[ERISA § 609(a)(1), 609(a)(8)]
Yes. Pursuant to section 609, an alternate recipient under a QMCSO is
treated as a beneficiary under the plan. Accordingly, in the view of the
Department, an alternate recipient is also treated as a dependent of the
participant under the plan. (However, if a QMCSO specifies that an alternate
recipient is to receive a particular level of coverage, or option, that is
available under the plan, but the participant is not enrolled in the particular
coverage or has not selected the particular option, the plan may be required to
change the participant’s enrollment to the extent necessary to provide the
specified coverage to the alternate recipient.)
[ERISA § 609(a)(7)(A)]
The medical child support order will ordinarily establish the obligations of
the parties for the child’s support. In most cases, the obligor under a
medical child support order will be the non-custodial parent who is a participant
in a group health plan and is responsible for the payment of any costs
associated with the provision of coverage.
If Federal or State withholding limitations prevent withholding from the
participant’s paycheck the additional contribution required to provide
coverage to the child under the terms of the plan, the employer should notify
the custodial parent, and the child support enforcement agency, if the agency is
involved. Unless the employer is able to withhold the necessary contribution
from the participant’s paycheck, the plan is not required to extend coverage
to the child. However, the custodial parent or the agency may be able to modify
the amount of cash support to be provided, in order to enable the employer to
withhold the required contribution to the plan. The participant may also
voluntarily consent to the withholding of an amount otherwise in excess of
applicable withholding limitations.
The plan should pay benefits to the alternate recipient, the custodial
parent, or the provider of health services to the child notwithstanding plan
terms that may require benefit payments be made to the participant. In some
instances, payment will be required to be made to the State child support
enforcement or Medicaid agency.
[ERISA §§ 609(a)(8), 609(a)(9), 609(b)(3), Social Security Act § 1908(a)(5)]
A plan may disenroll an alternate recipient at the same time and under the
same conditions as it can disenroll other dependents of participants under the
plan. For instance, if the plan terminates coverage when a participant
terminates employment, and neither the participant nor the alternate recipient
elects COBRA continuation coverage, the plan may discontinue coverage for the
alternate recipient. Similarly, if the plan ceases to provide coverage for
dependents who are over the age of 18, the coverage of an alternate recipient
who is over the age of 18 may be terminated (assuming that continuation coverage
is not elected).
Subject to the limitations on the imposition of pre-existing condition
restrictions and exclusions contained in section 701 of ERISA, an alternate
recipient would be subject to the plan’s generally applicable pre-existing
condition restrictions or exclusions. However, it is the view of the Department
that a group health plan’s receipt of a medical child support order would toll
the running of the 63-day break-in-coverage period for determining the child’s
creditable coverage. The time taken by the plan administrator to determine
whether the order is qualified would not count towards a 63-day break. In
addition, if the child had been previously covered under the plan and had been
disenrolled by the participant in anticipation of, e.g., divorce or separation,
it is the view of the Department that the period between the date the child’s
coverage is terminated and the date the plan administrator determines that an
order is qualified would also not count as part of the 63 day period.
This section discusses the National Medical Support Notice (Notice), which should be
used by State child support enforcement agencies to secure coverage for children
under their noncustodial parents' group health plans. The following subjects
What constitutes a National Medical Support Notice?
What is the role of a State child support enforcement agency?
What obligations do an employer and plan administrator have when they receive
a National Medical Support Notice?
How does an appropriately completed Notice satisfy the QMCSO requirements?
The National Medical Support Notice (Notice) is a standardized medical child
support order that is to be used by State child support enforcement agencies to
enforce medical child support obligations. The Department of Labor and the
Department of Health and Human Services adopted regulations on December 27,
2000, implementing the National Medical Support Notice provisions of the Child
Support Performance and Incentive Act of 1998 (CSPIA). These regulations appear
at 29 CFR § 2590.609-2 and 45 CFR § 303.32. CSPIA also requires plans
sponsored by churches and State and local governments to provide benefits in
accordance with the requirements of an appropriately completed Notice, although
the Department of Labor has no interpretive or enforcement authority over those
requirements. For questions with respect to these plans, contact your State
child support enforcement agency.
[ERISA § 609(a)(5)(C), Social Security Act § 466(a)(19)]
Pursuant to the changes made by CSPIA to the child support enforcement
program and the regulations issued by the Department of Health and Human
Services, the Notice is the exclusive document to be used by a child support
enforcement agency to enforce the provision of health care coverage to children
of noncustodial parents who are required to provide health care coverage through
any employment-related group health plan pursuant to a child support order and
for whom the employer is known to the agency.
[Social Security Act § 466(a)(19), 45 CFR § 303.32, CSPIA § 401(e) and (f)]
Ordinarily, an employer may expect to receive a Notice when a child support
enforcement agency initially enforces an employee’s medical support
obligation, or when an employee with a previously established medical support
obligation is newly hired. The Notice is comprised of Part A, Notice to Withhold
for Health Care Coverage (which includes an Employer Response), and Part B,
Medical Support Notice to Plan Administrator (which includes a Plan
If the employee named in the Notice is not an employee of the employer, if
the employer does not maintain or contribute to a plan that provides dependent
coverage, or if the named employee is among a class of employees (e.g. part-time
or non-union) not eligible for enrollment in a plan that provides dependent
coverage, the employer must check the appropriate box on the Employer Response
and return it to the issuing agency within 20 business days after the date of
the Notice (or sooner if reasonable).
Otherwise, the employer must transfer Part B of the Notice to the group
health plan (or plans) for which the child may be eligible for enrollment not
later than 20 business days after the date of the Notice.
For these purposes, the “date of the Notice” means the date that is
indicated as such on the Notice.
If the employer offers a number of different types of benefits (e.g., dental,
prescription) through separate plans, and the issuing agency has not specified
which or all are covered by the Notice, the employer should assume all plans are
covered by the Notice, and send copies of Part B of the Notice to each plan
The application of a waiting period (such as one requiring that a new
employee must be employed for a certain amount of time or work a certain number
of hours) before an employee may enroll in the group health plan does not affect
the employer’s obligation to transfer Part B to the plan administrator(s).
When transferring Part B of the Notice, the employer retains Part A. An
employer that transfers Part B of the Notice to a plan administrator(s) may
later need to use the Employer Response after it has been notified of the
qualification of the Notice and has determined that necessary employee
contributions cannot be withheld from wages.
[Social Security Act § 466(a)(19), 45 CFR § 303.32(c)]
A plan administrator who receives a National Medical Support Notice must
review the Notice and determine whether it is appropriately completed. The
administrator must complete the Plan Administrator Response (included with Part
B of the Notice), indicating whether the Notice is a QMCSO, and return it to the
State agency that issued the Notice within 40 business days after the date of
If the plan administrator determines that the Notice is appropriately
completed, the administrator is required to treat the Notice as a QMCSO. The
plan administrator must in that case inform the State agency that issued the
Notice when coverage under the plan of the child named in the Notice will begin
and must provide the custodial parent of the child (or, in some cases, a named
State official) with information about the child’s coverage under the plan,
such as the plan’s summary plan description, any forms or documents necessary
to make claims under the plan, etc.
If the participant is not enrolled and there is more than one option
available under the plan for coverage of the child, the plan administrator must
also use the Plan Administrator Response to notify the agency of that fact, and
inform them of the available options for coverage. If the agency does not
then respond within 20 business days and the plan has a “default option,”
the plan administrator may enroll the child in the default option.
The Department of Labor has issued a regulation, 29 CFR 2590.609-2, that
provides guidance on how administrators of group health plans must deal with
Notices they receive.
[ERISA § 609(a)(5)(C), 29 CFR § 2590.609-2]
An “appropriately completed” Notice is a notice that includes the
The name of an issuing State child support enforcement agency;
The name and mailing address of the employee, enrolled or eligible for
enrollment, who is obligated by a State court or administrative order to provide
medical support for each named child;
The name and mailing address of each child covered by the Notice. The name
and address of a State or local official may be substituted for the address of
A notice may be “appropriately completed” even if some items of
information in the Notice are not included as long as the Notice includes the
information listed above. In addition, if any of the necessary information
described above has been omitted but is reasonably available to the plan
administrator, the Notice should not fail to be “appropriately completed”
solely because of such omission.
An “appropriately completed” Notice satisfies the informational
requirements of the QMCSO provisions by:
Providing the name and last known mailing address (if any) of the participant
and the name and mailing address of each child covered by the order;
Having the child support enforcement agency identify either the specific type
of coverage or all available group health coverage;
Instructing the plan administrator that if a Notice does not designate either
specific type(s) of coverage or all available coverage, it should assume that
all are designated, and further instructing the plan administrator that if a
group health plan has multiple options and the participant is not enrolled, the
agency will make a selection after the Notice is qualified and, if the agency
does not respond within 20 business days, the child will be enrolled under the
plan’s default option if there is one; and
Specifying that the period of coverage may end for the named child only when
similarly situated dependents are no longer eligible for coverage under the
terms of the plan, or upon the occurrence of events specified in the Notice.
A Notice also requires the plan to provide to a named child only those
benefits that the plan provides to any dependent of a participant who is
enrolled in the plan, and any other benefits that are necessary to meet the
requirements of the State laws relating to medical child support described in
As noted above in Q 1-14, a plan administrator may not find a medical child
support order, including a Notice, to be not qualified solely because the
participant is subject to a waiting period (such as one requiring a
certain number of months or hours worked). A waiting period
may, however, affect the procedures necessary for enrollment of the named child.
Assuming a Notice otherwise meets the requirements to be a QMCSO:
For short waiting periods (90 days or less remaining at the time of the plan
administrator’s receipt of Part B), the plan administrator qualifies the
Notice, and waits until the expiration of the necessary time to enroll the child
and notify the employer of the need, if any, to withhold from the employee’s
wages to provide such coverage.
For long waiting periods (greater than 90 days remaining at the time of the
plan administrator’s receipt of Part B, or the period is measured by other
means, such as hours worked), the plan administrator should inform the employer
of the waiting period, and wait for notification from the employer of the
employee’s satisfaction of the waiting period.
Following notification of qualification, the employer must determine if
necessary employee contributions may be withheld from the employee’s wages
without violating any applicable withholding limits. Part A of the Notice
contains information for the employer regarding Federal and State limitations on
withholdings, any applicable withholding prioritization laws, and the duration
of the withholding obligation. If withholding limits would prevent the employer
from withholding the employee contributions necessary for coverage, the employer
must use the Employer Response on Part A to notify the issuing IV-D Agency of
its inability to withhold the necessary amounts. If the amounts necessary for
coverage may be withheld, then the employer must initiate such withholding and
transmit the withheld amounts to the group health plan to pay for the child’s
The Notice provides that the employee named in the Notice is liable for any
employee contributions required under the plan for enrollment of the children.
However, if Federal or State withholding limitations prevent the withholding of
the required employee contributions from the employee’s paycheck, the plan is
not required to provide coverage to the child. The employer is required to
notify the State agency if such withholding limitations prevent the withholding
of the required employee contributions. (See Qs 1-25 and 1-26.)
The following information about ERISA and other laws may be useful sources of
information about obtaining health care coverage and medical care for children:
Employee Benefits Security Administration - More information about ERISA, COBRA, the Health
Insurance Portability and Accountability Act (HIPAA), and other health
benefits laws can be found at EBSA’s Web site. The Web site also
contains links to a number of other sites with information about various health
Two agencies in the Department of Health and
Human Services play significant roles in the provision of health care coverage
to children. The Office of Child Support Enforcement is responsible for
establishing standards and providing guidance for the Child Support Enforcement
Program under Title IV-D of the Social Security Act.
Centers for Medicare &
Medicaid Services - The Centers for Medicare and Medicaid
Services administers Medicaid and the State Children’s Health Insurance Program (also known as SCHIP) and provides additional guidance under HIPAA and other recently
enacted health-related laws.
National Child Support
Enforcement Association - The National Child Support Enforcement Association
a nonprofit membership organization comprised primarily of State and local child
support enforcement agencies, as well as staff and management of State child
support enforcement agencies.
The Eastern Regional InterState Child
Support Association (ERICSA) and the Western InterState Child Support
Enforcement Council (WICSEC) are child support enforcement professional
organizations focusing on issues of interstate child support enforcement.
Each State has a child support enforcement agency. Sometimes this agency is
located in the State attorney general’s office, but it is frequently found as
part of the State’s department of social or human services.
National Medical Support Notice - Notice to Withhold for Health Care Coverage, OMB No. 0970-0222 - This Notice is issued under section 466(a)(19) of the Social Security Act,
section 609(a)(5)(C) of the Employee Retirement Income Security Act of 1974 (ERISA),
and for State and local government and church plans, sections 401(e) and (f) of
the Child Support Performance and Incentive Act of 1998.
National Medical Support Notice - Medical Support Notice to Plan Administrator, OMB No. 1210-0113 - This Notice is issued under section 466(a)(19) of the Social Security Act,
section 609(a)(5)(C) of the Employee Retirement Income Security Act of 1974, and
for State and local government and church plans, sections 401(e) and (f) of the
Child Support Performance and Incentive Act of 1998. Receipt of this Notice from
the Issuing Agency constitutes receipt of a Medical Child Support Order under
applicable law. The rights of the parties and the duties of the plan
administrator under this Notice are in addition to the existing rights and
duties established under such law.
As used in this booklet, the term “group health plan” refers to that
term as defined in section 607(1) of ERISA and means generally any welfare plan
established or maintained by an employer or employee organization (or both) that
provides medical care to employees or their dependents directly or through
insurance, reimbursement, or otherwise.