2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 8
Court Ordered Coverage for a Child
Federal law requires the Health Care Plan, under certain circumstances, to provide coverage for your children. The
details of these requirements are summarized below.
The Employer shall enroll for immediate coverage under this Health Care Plan any Child of a Covered Employee,
who is the subject of a “qualified medical child support order” (“QMCSO”). Coverage under the Health Care Plan
will be effective as of the later of the date specified in the order or the date the Employer determines that the order
is a QMCSO. Any required contribution for coverage pursuant to this section will be deducted from your pay in
accordance with the Employer’s payroll schedule and policies.
A QMCSO is defined as a child support decree or order issued by a court (or a state administrative agency that has
the force and effect of law under applicable state law) that obligates you to support or provide health care coverage
to your child and includes certain information concerning such coverage. The Employer will determine whether any
child support order it receives constitutes a QMCSO. Except for QMCSO’s, no child is eligible for Health Care Plan
coverage, even if you are required to provide coverage for that child under the terms of a separation agreement or
court order, unless the child is an eligible Child under this Health Care Plan. Procedures for determining a QMCSO
may be obtained, free of charge, by contacting the Employer.
Annual Enrollment Period
You may enroll your Dependents for coverage during the Health Care Plan’s annual enrollment period, designated
by the Health Care Plan Sponsor and communicated to you prior to such enrollment period. During this time, you
will be permitted to make changes to any existing benefit elections. Benefit elections made during the annual
enrollment period will be effective as of January 1st and will remain in effect until the next annual enrollment period
unless you or your Dependent experiences a Special Enrollment Event. A Covered Employee who fails to make an
election during annual enrollment will automatically retain their present coverage.
Late Enrollment
If you did not enroll your Dependents during the original 31-day eligibility period, you may do so by making written
application to the Employer during the annual enrollment period (refer to annual enrollment period section above).
In these circumstances, your eligible Dependents will be considered Late Enrollees.
Special Enrollment Event
A special enrollment event occurs when your Dependents suffer a loss of other health care coverage, when they
become eligible for a state premium assistance subsidy or you acquire a new Dependent as a result of marriage,
birth, adoption or placement for adoption. In these circumstances, your eligible Dependents will be considered
Special Enrollees and will be eligible for coverage under the Health Care Plan, subject to your timely notification of
the Employer of the special enrollment date (generally, 31 days, except as specifically provided below).
Each special enrollment event is more fully described below:
(1)
Loss of Other Coverage (other than under Medicaid or SCHIP). If you declined enrollment for your
Dependents (including your Spouse) because your Dependents had other health coverage (including
coverage under a group health plan sponsored by a governmental or educational institution, a medical care
program of the Indian Health Service or of a tribal organization), you may enroll your Dependents for coverage
under this Health Care Plan if the other health coverage is lost as a result of one of the following; provided,
however, you submitted a written statement to the Employer when your Dependents were initially eligible
stating that other health coverage was the reason for declining enrollment under this Health Care Plan:
(a)
The other health coverage was under COBRA and the maximum continuation period available under
COBRA has been exhausted;
(b)
Loss of eligibility under the other health coverage for reasons other than non-payment of the required
contribution or premium, making a fraudulent claim or intentional misrepresentation of a material fact
in connection with the other plan; or
(c)
Employer contributions cease for the other health coverage.
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