Ohio Admin. Code 5101:12-57-10.2 - Responsibility of health plan administrator
(A) In accordance with section
3119.37
of the Revised Code, upon receipt of the OMB 0970-0222, "National Medical
Support Notice" (as referenced in rule
5101:12-57-99
of the Administrative Code), (NMSN) and the JFS 03377, "Employer/Health Plan
Administrator Health Insurance Verification Request" (effective or revised
effective date as indentified
identified in rule
5101:12-57-99
of the Administrative Code), the health plan administrator is required to:
(1) Complete and return part B of the NMSN to
the child support enforcement agency (CSEA) within forty business days of the
date of the NMSN; and
(2) Comply
with the enrollment requirements in accordance with the instructions contained
in the NMSN.
(B) When
there is more than one health coverage option available under the plan and the
health insurance obligor is not enrolled in any of the options:
(1) The health plan administrator is required
to attach to part B 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 under each
option and whether there is a limited service area for any option.
(2) When the health plan has a default option
and the CSEA fails to notify the health plan administrator of the health
coverage selection within twenty business days, the health plan administrator
is required to enroll the child in the health plan's default option.
(C) After the child has been
enrolled in a health plan option, the health plan administrator is required to
complete and return the JFS 03377 to the CSEA.
(D) In accordance with section
3119.422
of the Revised Code, nothing in rule
5101:12-47-01,
5101:12-57-01,
or
5101:12-57-10
to 5101:12-57-10.6 of the Administrative Code shall be construed to require the
health plan administrator to accept for enrollment any child who does not meet
the underwriting standards of the health insurance or health care policy,
contract, or plan for which application is made.
Notes
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.37, 3119.422
Prior Effective Dates: 01/07/1985, 08/01/1986, 12/01/1987, 12/20/1988, 09/01/1989, 08/01/1990, 06/01/1991, 11/01/1991, 07/15/1992, 04/01/1993, 01/01/1998, 10/02/2003, 01/01/2007, 05/01/2012, 01/15/2017
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