(1) A plan administrator who receives a
National Medical Support Notice (NMSN) must respond to the NMSN within forty
business days after the date on the NMSN.
(2) If the
obligated parent and the
children
are to be enrolled in a health insurance plan, the plan administrator must:
(a) Notify the obligated parent, each child,
and the custodial parent (CP) (if the obligated parent is not the CP) that
coverage of the children is or will become available (notifying the CP is
considered the same as notifying the child if they live at the same address);
and
(b) If not previously provided,
send the CP a description of the coverage available, including the effective
date of coverage, a summary plan description and any forms or information
necessary to start coverage, and information on how to submit claims for
benefits.
(3) If there
is more than one option available under the plan and the
obligated parent is
not yet enrolled, the plan administrator must:
(a) Provide to the division of child support
(DCS) copies of applicable summary plan descriptions for available coverage,
including the additional participant contribution necessary to obtain coverage
for the children under each option and whether any option has a limited service
area; and
(b) If the plan has a
default option, enroll the children in the plan's default option if the plan
administrator has not received DCS' election within twenty business days of the
date the plan administrator returned the response to DCS; or
(c) If the plan does not have a default
option, enroll the children in the option selected by DCS.
(4) If the obligated parent is subject to a
waiting period that expires within ninety days from the date the plan
administrator receives the NMSN, the plan administrator must enroll the
children named in the NMSN immediately.
(5) If the
obligated parent is subject to a
waiting period that expires more than ninety days from the date the plan
administrator receives the
NMSN, the plan administrator must notify the
employer, DCS, the obligated parent and the
CP (if the obligated parent is not
the
CP) of the waiting period. When the waiting period has expired, the plan
administrator must:
(a) Enroll the obligated
parent and the children named in the NMSN, as provided in subsection (2) or (3)
above; and
(b) Notify the
employer
of enrollment so that the
employer may determine if the NCP's income is
sufficient to withhold health insurance premiums, and then either withhold
accordingly or notify DCS, as provided in WAC
388-14A-4125(3)(b).
(6) If the
obligated parent is
subject to 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), the plan administrator must notify the
employer, DCS, the
obligated parent and the
CP (if the
CP is not the obligated parent) of the
waiting period. When the waiting period has expired, the plan administrator
must:
(a) Enroll the obligated parent and the
children named in the NMSN, as provided in subsection (2) or (3) above;
and
(b) Notify the
employer of
enrollment so that the
employer may determine if the obligated parent's income
is sufficient to withhold health insurance premiums, and then either withhold
accordingly or notify DCS, as provided in WAC
388-14A-4125(3)(b).
(7) If the
plan administrator
determines that the
NMSN does not constitute a qualified medical child support
order as defined by ERISA, the plan administrator must:
(a) Notify DCS using the part of the NMSN
called the plan administrator response; and
(b) Notify the obligated parent, the CP (if
the CP is not the obligated parent) and the children of the specific reasons
for the determination. A copy of the plan administrator response is considered
sufficient notice under this section.