§ 514C.9 — Medical support — insurance requirements

Iowa § 514C.9

• Jurisdiction: Iowa
• Title XIII: COMMERCE
• Ch. 514C: SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES

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1. An insurer shall not deny coverage or enrollment of a child under the health plan of the
obligor upon any of the following grounds:
a. The child is born out of wedlock.
11 SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES, §514C.9
b. The child is not claimed as a dependent on the obligor’s federal income tax return.
c. The child does not reside with the obligor or in the insurer’s service area. This
section shall not be construed to require a health maintenance organization regulated under
chapter 514B to provide any services or benefits for treatment outside of the geographic area
described in its certificate of authority which would not be provided to a member outside of
thatgeographicareapursuanttothetermsofthehealthmaintenanceorganization’scontract.
2. An insurer of an obligor providing health care coverage to the child for which the
obligor is legally responsible to provide support shall do all of the following:
a. Provide information to the obligee or other legal custodian of the child as necessary for
the child to obtain benefits through the coverage of the insurer.
b. Allowtheobligeeorotherlegalcustodianofthechild, ortheproviderwiththeapproval
of the obligee or other legal custodian of the child, to submit claims for covered services
without the approval of the obligor.
c. Make payment on a claim submitted in paragraph “b” directly to the obligee or
other legal custodian of the child, the provider, or the state medical assistance agency for
claims submitted by the obligee or other legal custodian of the child, by the provider with
the approval of the obligee or other legal custodian of the child, or by the state medical
assistance agency.
3. If an obligor is required by a court order or administrative order to provide health
coverage for a child and the obligor is eligible for dependent health coverage, the insurer
shall do all of the following:
a. Allow the obligor to enroll under dependent coverage a child who is eligible for
coverage pursuant to the applicable terms and conditions of the health benefit plan and
the standard enrollment guidelines of the insurer without regard to an enrollment season
restriction.
b. Enroll a child who is eligible for coverage under the applicable terms and conditions
of the health benefit plan and the standard enrollment guidelines of the insurer, without
regard to any time of enrollment restriction, under dependent coverage upon application by
the obligee or other legal custodian of the child or by the department of health and human
servicesintheeventanobligorrequiredbyacourtorderoradministrativeorderfailstoapply
for coverage for the child.
c. Maintain coverage and not cancel the child’s enrollment unless the insurer obtains
satisfactory written evidence of any of the following:
(1) The court order or administrative order is no longer in effect.
(2) Thechildiseligiblefororwillenrollincomparablehealthcoveragethroughaninsurer
which shall take effect not later than the effective date of the cancellation of enrollment of
the original coverage.
(3) The employer has eliminated dependent health coverage for its employees.
(4) The obligor is no longer paying the required premium because the employer no longer
owes the obligor compensation, or because the obligor’s employment has terminated and the
obligor has not elected to continue coverage.
4. A group health plan shall establish reasonable procedures to determine whether a child
is covered under a qualified medical child support order issued pursuant to chapter 252E.
The procedures shall be in writing, provide for prompt notice of each person specified in the
medical child support order as eligible to receive benefits under the group health plan upon
receipt by the plan of the medical child support order, and allow an obligee or other legal
custodian of the child under chapter 252E to designate a representative for receipt of copies
of notices in regard to the medical child support order that are sent to the obligee or other
legal custodian of the child and the department of health and human services’ child support
services.
5. For purposes of this section, unless the context otherwise requires:
a. “Child” means a person, other than an obligee’s spouse or former spouse, who is
recognized under a qualified medical child support order as having a right to enrollment
under a group health plan as the obligor’s dependent.
b. “Court order” or “administrative order” means a ruling by a court or administrative
agency in regard to the support an obligor shall provide to the obligor’s child.
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c. “Insurer” means an entity which offers a health benefit plan.
d. “Obligee” means an obligee as defined in section 252E.1.
e. “Obligor” means an obligor as defined in section 252E.1.
f. “Qualified medical child support order” means a child support order which creates or
recognizesachild’srighttoreceivehealthbenefitsforwhichthechildiseligibleunderagroup
health benefit plan, describes or determines the type of coverage to be provided, specifies the
length of time for which the order applies, and specifies the plan to which the order applies.