§ 26-15-135 — Coverage of children

Wyoming § 26-15-135

• Jurisdiction: Wyoming
• Title 26: Insurance Code
• Ch. 15: THE INSURANCE CONTRACT

Text

(a) No insurance company, multi-employer trust or other
provider of an individual, group or blanket health insurance
product in this state shall:
(i) Refuse to accept and honor an otherwise valid
claim for a covered service which is filed by either parent of a
covered child, or by the department of family services in the
case of an assignment under W.S. 20-6-106, who submits valid
copies of medical bills;
(ii) Refuse to provide medical insurance coverage of
a child under the health plan of the child's parent on the
grounds that:
(A) The child was born out of wedlock;
(B) The child is not claimed as a dependent on
the parent's federal tax return; or
(C) The child does not reside with the parent or
in the insurer's service area.
(iii) Refuse to provide medical insurance coverage
for an otherwise insurable child under the policy if the child
for whom the claim is made is presumed to be the natural child
of the insured under W.S. 14-2-504 or 14-2-822.
(b) Where a child has health coverage through an insurer
of a noncustodial parent or a parent sharing custody or
temporary control of the child the insurer shall:
(i) Provide such information to either parent sharing
custody or temporary control of the child as may be necessary
for the child to obtain benefits through that coverage;
(ii) Permit either parent sharing custody or
temporary control of the child, or the provider with either
parent's approval, to submit claims for covered services without
the approval of the other parent; and
(iii) Make payments on claims submitted in accordance
with paragraph (ii) of this subsection directly to the parent
who paid for the services, the provider or the department of
health as administrator of the Wyoming Medical Assistance and
Services Act.
(c) Where a parent is required by a court or
administrative order to provide health coverage for a child and
the parent is eligible for family health coverage, the insurer
shall be required:
(i) To permit the parent to enroll under the family
coverage, a child who is otherwise eligible for the coverage
without regard to any enrollment season restrictions;
(ii) If the parent is enrolled but fails to make
application to obtain coverage for the child, to enroll the
child under family coverage upon application of the child's
other parent, the department of health in administering the
Wyoming Medical Assistance and Services Act, or the department
of family services in administering the child support
enforcement program;
(iii) To complete and return the plan administrator
response in conjunction with the national medical support notice
to the department of family services within forty (40) business
days after the date of the notice; and
(iv) Not to disenroll or eliminate coverage of the
child unless the insurer is provided satisfactory written
evidence that:
(A) The court or administrative order is no
longer in effect; or
(B) The child is or will be enrolled in
comparable health coverage through another insurer which will
take effect not later than the effective date of disenrollment.
(d) An insurer may not impose requirements on a state
agency, which has been assigned the rights of an individual
eligible for medical assistance under the Wyoming Medical
Assistance and Services Act and covered for health benefits from
the insurer, that are different from requirements applicable to
an agent or assignee of any other individual so covered.