Protecting your Children’s Health Care Coverage After a Divorce

Protecting your Children’s Health Care Coverage After a Divorce

There is hardly a subject more widely discussed and debated than health care coverage. If you are contemplating a divorce, or are currently pursuing one, and you have children, you are no doubt wondering how to protect your children’s access to health care coverage and services once a divorce were final. A Qualified Medical Child Support Order (QMCSO) might just be the underutilized tool you need to ensure that your child(ren) continue to receive the coverage they deserve.

Aside from an acronym that doesn’t quite just roll off the tongue, what else is QMCSO good for? I’ll help fill you in on a few key questions: (1) what is a QMCSO, (2) what does a QMCSO do, and (3) what are the requirements of a QMCSO?

(1) What is a QMCSO?

A QMCSO is an order made pursuant to the laws of a state court that provides for child support or health benefit coverage for a child of a participant under a group health plan.  It creates or recognizes the rights of an alternate recipient (not the participant) to receive benefits for which a participant or beneficiary is eligible under a group health plan.  As indicated in its name the order must be “Qualified”, meaning it must contain certain information and meet the requirements of the QMCSO provisions, which I’ll get to later.

(2) What does a QMCSO do?

In short, a QMCSO orders a health insurance provider to comply with state laws regarding medical child support.  Each state is required by Congress under the Employee Retirement Income Security Act of 1974 (ERISA) to have in place specific state laws relating to medical child support in order to receive certain federal funds.  Each state must have laws that:

1. a.  Require health insurers to enroll a child under his or her parent’s health insurance even if:
   1.   i. the child is born out of wedlock;
      1.   ii.  the child does not reside with the insured parent
      2.   iii.  the child does not live in the insurer’s service area;

1.   iv. or the child is not claimed as a dependent on the parent’s federal income tax return;

1. b. Require health insurers to enroll a child without regard to the plan’s open enrollment restrictions;
2. c. Require employers and insurers to comply with orders requiring a parent to provide health insurance for a child; and
3. d. Require insurers to permit a custodial parent to file claims on behalf of his or her child under the non-custodial parent’s health insurance, and to make benefit payments directly to the custodial parent or health care provider.

Note that a QMCSO cannot require a plan to provide any type or form of benefit not otherwise provided by the plan, except to the extent necessary to meet the requirements of the laws I just mentioned.

(3) What are the requirements of a QMCSO?

A QMCSO requires that one of the parents be ordered to provide health care coverage for a child under a group health plan.  It does not apply to government-funded health insurance plans like Medicaid because ERISA, the law which allows for the creation of a QMCSO, applies to private sector employers only.

So in short, a QMCSO can help you: if you want primary custody, but don’t want your child to lose the non-custodial parent’s health care coverage; if you want to be able to submit a claim despite not being a participant or beneficiary of the other parent’s health plan; or if you need to enroll your child outside of a provider’s open enrollment period.

If you’re feeling overwhelmed by this and other complexities involved in divorce, you are not alone. But that’s what we’re here for. One of our experienced family law attorneys at Curran Moher Weis can help make the difficult experience of divorce easier by helping you navigate whether you qualify for a QMCSO and whether it would be beneficial to you in your case.  Reach out to us to request a consultation here and learn more about child support in Virginia here.