Article 16: Nine Federal Laws You Should Know About >>

16.6 Qualified Medical Child Support Order (QMCSO)

A Qualified Medical Child Support Order (QMCSO) is a judgment, decree or order issued by a court (or through a state administrative process) usually in a divorce case, that requires a group health plan to provide coverage to a child of a Participant, and which meets certain legal requirements. As required by law, the trust fund will provide benefits under such a Medical Child Support Order (MCSO) if it is “qualified.”

A QMCSO recognizes a child's right to receive trust fund benefits, as a beneficiary of an eligible trust fund Participant. The child, to be covered by the benefits of this Plan, must meet the age requirement and definition of eligible Dependent as defined previously under Article 4.10 Eligible Dependents.

Below are outlined the steps which will be followed in order to establish and determine the qualified status of a MCSO.

1. You must provide the Administrative Office with a copy of your Court ordered MCSO.
2. Within thirty (30) days after receipt of the MCSO, the Administrative Office will notify you and the eligible Dependent (through his or her custodial parent, guardian or representative), in writing, if the MCSO is “qualified.” If the order is “qualified” and hence a QMCSO, the Plan will provide information on enrolling the child in the Plan.
3. If the Plan determines that the Court order does not constitute a QMCSO, or additional information is required, you and the eligible Dependent (through his or her custodial parent, guardian or representative) will be notified in writing by the Plan.
   1. If the Plan determines that the MCSO is not “qualified,” the notice shall describe the reasons for this decision. You have a right to appeal a denial, and the Plan's appeals procedures will be included along with the notice of denial.
   2. If additional information is required, you will be notified as to what is needed, and will have sixty (60) days to respond. If you do not respond within sixty (60) days, your request to cover a child under the terms of the MCSO will be deemed canceled.