§ 40-5-812 — Obligations Of Health Benefit Plan

40-5-812 . Obligations of health benefit plan. (1) Upon receipt of a medical support order requiring a parent to provide coverage for a child or an order requiring enrollment of a child pursuant to 40-5-810 , the administrator of a health benefit plan who receives the order shall accept the order as a valid authorization to enroll or provide benefits to the child. The health benefit plan may rely upon the face of the order and need not inquire as to its legal sufficiency.
(2) A plan administrator shall give the nonobligated parent, the department, whenever public assistance is paid to the child, or a third-party custodian all notices and correspondence from the plan and allow them to freely communicate and interact with the plan in all respects regarding the child's benefits as fully and effectively as if done by the obligated parent.
(3) A copy of the medical support order or an order requiring enrollment of the child pursuant to 40-5-810 must be accepted by the plan administrator as a request and application of the eligible obligated parent requesting that new or continued benefits, including continuation coverage available under COBRA, be provided for the child. As soon as practical and no later than 30 days after receipt of the order or upon the obligated parent obtaining eligibility, the child must be enrolled under the plan as an individual entitled to available benefits. Enrollment may not be delayed until an open enrollment period.
(4) If a plan is provided by an employer or other payor of income, the payor shall deduct the necessary premiums, if any, from the income of the obligated parent and remit the premiums to the plan as provided in 40-5-813 .
(5) Within 30 days after receipt of a copy of a medical support order or within 40 working days after the date of an order issued pursuant to 40-5-810 , the health benefit plan shall give written notice to both parents, to the department, and to any third-party custodian setting forth the status of the child's enrollment in the plan and the addresses and telephone numbers of the offices where further information can be obtained and where changes of address and other updated information should be submitted.
(6) If coverage is transferred to a different plan, within 30 days of transfer, the new plan shall provide written notice to both parents, to the department, whenever public assistance is paid for the child, or to the third-party custodian setting forth the status of the child's enrollment in the plan and the addresses and telephone numbers of the offices where further information can be obtained and where changes of address and other updated information should be submitted.
(7) A plan administrator may not terminate a child's coverage unless:
(a) written evidence shows that the medical support order or the order requiring enrollment of the child pursuant to 40-5-810 is no longer in effect, that the child will be enrolled in another health benefit plan, or that individual insurance is provided;
(b) the employer, union, or other group eliminates coverage for all members or employees;
(c) the plan is available through the obligated parent's employer or other payor of income and the obligated parent's employment or right to receive income from the payor is terminated and continued coverage under COBRA is not available or the time for such coverage is expired; or
(d) the plan is available through the obligated parent's employer or other payor of income, the amount of the premium or the premium together with child support exceeds the limits in this section, and the other parent, the department, or the third-party custodian has not cured the insufficiency under 40-5-811 .

Legislative History

En. Sec. 12, Ch. 504, L. 1995; amd. Sec. 8, Ch. 431, L. 2005.