CHAPTER 252E MEDICAL SUPPORT
Effective for support orders entered on or after July 1, 1990; prior orders; §
252E.16
252E.1 DEFINITIONS.
As used in this chapter, unless the context otherwise requires:
1. "Accessible" means any of the following, unless otherwise
provided in the support order:
a. The health benefit plan does not have service area limitations
or provides an option not subject to service area limitations.
b. The health benefit plan has service area limitations and the
dependent lives within thirty miles or thirty minutes of a network
primary care provider.
2. "Basic coverage" means coverage provided under a health
benefit plan that at a minimum provides coverage for emergency care,
inpatient and outpatient hospital care, physician services whether
provided within or outside a hospital setting, and laboratory and
x-ray services.
3. "Child" means a person for whom child or medical support may
be ordered pursuant to chapter 234, 239B, 252A, 252C, 252F, 252H,
252K, 598, 600B, or any other chapter of the Code or pursuant to a
comparable statute of a foreign jurisdiction.
4. "Department" means the department of human services, which
includes but is not limited to the child support recovery unit, or
any comparable support enforcement agency of another state.
5. "Dependent" means a child, or an obligee for whom a court may
order coverage by a health benefit plan pursuant to section 252E.3.
6. "Enroll" means to be eligible for and covered by a health
benefit plan.
7. "Health benefit plan" means any policy or contract of
insurance, indemnity, subscription or membership issued by an
insurer, health service corporation, health maintenance organization,
or any similar corporation, organization, or a self-insured employee
benefit plan, for the purpose of covering medical expenses. These
expenses may include but are not limited to hospital, surgical, major
medical insurance, dental, optical, prescription drugs, office
visits, or any combination of these or any other comparable health
care expenses.
8. "Insurer" means any entity which provides a health benefit
plan.
9. "Medical support" means either the provision of a health
benefit plan, including a group or employment-related or an
individual health benefit plan, or a health benefit plan provided
pursuant to chapter 514E, to meet the medical needs of a dependent
and the cost of any premium required by a health benefit plan, or the
payment to the obligee of a monetary amount in lieu of a health
benefit plan, either of which is an obligation separate from any
monetary amount of child support ordered to be paid. Medical support
is not alimony.
10. "National medical support notice" means a notice as
prescribed under 42 U.S.C. § 666(a)(19) or a substantially similar
notice, that is issued and forwarded by the department to enforce
medical support provisions of a support order.
11. "Obligee" means a parent or another natural person legally
entitled to receive a support payment on behalf of a child.
12. "Obligor" means a parent or another natural person legally
responsible for the support of a dependent.
13. "Order" means a support order entered pursuant to chapter
234, 252A, 252C, 252F, 252H, 252K, 598, 600B, or any other support
chapter, or pursuant to a comparable statute of a foreign
jurisdiction, or an ex parte order entered pursuant to section
252E.4. "Order" also includes a notice of such an order issued by
the department.
14. "Plan administrator" means the employer or sponsor that
offers the health benefit plan or the person to whom the duty of plan
administrator is delegated by the employer or sponsor offering the
health benefit plan, by written agreement of the parties.
15. "Primary care provider" means a physician who provides
primary care who is a family or general practitioner, a pediatrician,
an internist, an obstetrician, or a gynecologist.
90 Acts, ch 1224, § 25; 92 Acts, ch 1195, § 505; 93 Acts, ch 78,
§20; 93 Acts, ch 79, §46; 97 Acts, ch 41, § 32; 2000 Acts, ch 1096,
§1; 2002 Acts, ch 1018, §3
Referred to in § 252C.1, 252E.6A, 252H.2, 514C.9, 600B.25
252E.2 ORDER FOR MEDICAL SUPPORT.
1. An order requiring the provision of coverage under a health
benefit plan is authorization for enrollment of the dependent if the
dependent is otherwise eligible to be enrolled. The dependent's
eligibility and enrollment for coverage under such a plan shall be
governed by all applicable terms and conditions, including, but not
limited to, eligibility and insurability standards. The dependent,
if eligible, shall be provided the same coverage as the obligor.
2. An insurer who is subject to the federal Employee Retirement
Income Security Act, as codified in 29 U.S.C. § 1169, shall provide
benefits in accordance with that section which meet the requirements
of a qualified medical child support order. For the purposes of this
subsection "qualified medical child support order" means and includes
a medical child support order as defined in 29 U.S.C. § 1169, or a
child support order which creates or recognizes the existence of a
child's right to, or assigns to a child the right to, receive
benefits for which a participant or child is eligible under a group
health plan or a notice of such an order issued by the department,
and which specifies the following:
a. The name and the last known mailing address of the participant
and the name and mailing address of each child covered by the order
except that, to the extent provided in the order, the name and
mailing address of an official of the department may be substituted
for the mailing address of the child.
b. A reasonable description of the type of coverage to be
provided to each child, or the manner in which the type of coverage
is to be determined.
c. The period during which the coverage applies.
3. The obligor shall take all actions necessary to enroll and
maintain coverage under a health benefit plan for a dependent at the
obligor's present and all future places of employment.
4. A medical support order of a foreign jurisdiction may be
entered or filed with the clerk of the district court. However,
entry of such a medical support order under this subsection does not
constitute registration of that medical support order.
90 Acts, ch 1224, § 26; 92 Acts, ch 1195, § 506; 93 Acts, ch 78,
§21; 94 Acts, ch 1171, §26; 97 Acts, ch 175, § 73; 98 Acts, ch 1170,
§32; 2000 Acts, ch 1096, §2; 2002 Acts, ch 1018, §4
Referred to in § 252E.4, 252E.8
252E.3 HEALTH BENEFIT COVERAGE OF OBLIGEE.
For cases for which services are being provided pursuant to
chapter 252B, the order may require an obligor providing a health
benefit plan for a child to also provide a health benefit plan for
the benefit of an obligee if the obligee is eligible for enrollment
under the plan in which the child or the obligor is enrolled, and if
the plan is available at no additional cost.
90 Acts, ch 1224, §27
Referred to in § 252E.1, 252E.6
252E.4 ORDER TO EMPLOYER.
1. When a support order requires an obligor to provide coverage
under a health benefit plan, the district court or the department may
enter an ex parte order directing an employer to take all actions
necessary to enroll an obligor's dependent for coverage under a
health benefit plan or may include the provisions in an ex parte
income withholding order or notice of income withholding pursuant to
chapter 252D. The child support recovery unit, where appropriate,
shall issue a national medical support notice to an employer within
two business days after the date information regarding a newly hired
employee is entered into the centralized employee registry and
matched with a noncustodial parent in the case being enforced by the
unit. The department may amend the information in the ex parte order
or may amend or terminate the national medical support notice
regarding health insurance provisions if necessary to comply with
health insurance requirements including but not limited to the
provisions of section 252E.2, subsection 2, or to correct a mistake
of fact.
2. The obligee, district court, or department may forward either
the support order containing the provision for coverage under a
health benefit plan or the ex parte order provided for in subsection
1 to the obligor's employer.
3. This chapter shall be constructive notice to the obligor of
enforcement and further notice prior to enforcement is not required.
4. The order requiring coverage is binding on all future
employers or insurers if the dependent is eligible to be enrolled in
the health benefit plan under the applicable plan terms and
conditions.
90 Acts, ch 1224, §28; 93 Acts, ch 78, §22; 96 Acts, ch 1141, §
24; 97 Acts, ch 175, § 74; 2002 Acts, ch 1018, §5
Referred to in § 252E.1, 252E.5, 252E.6A
252E.5 EFFECT OF ORDER ON EMPLOYER.
1. When the order has been forwarded to the obligor's employer
pursuant to section 252E.4, the order is binding on the employer and
the employer's insurer to the extent that the dependent is eligible
to be enrolled in the plan under the applicable terms and conditions
of the health benefit plan and the standard enrollment guidelines of
the insurer. The employer shall allow enrollment of the dependent at
any time, notwithstanding any enrollment season restrictions. If a
provision of this section conflicts with a provision in the national
medical support notice, or in subsection 8, the provision in the
notice and subsection 8 shall apply.
2. The employer shall forward a copy of the order to the insurer
and request enrollment of the dependent in the health benefit plan.
If the obligor fails to apply to obtain coverage for the dependent,
the employer shall accept an application to enroll a dependent which
has been signed by the obligee or other legal custodian of a child or
by the department. Within sixty days of receipt of the order or
within sixty days of receipt of application, whichever is earlier,
the insurer shall determine whether the dependent is eligible for
enrollment under the plan and shall notify the employer of the
dependent's eligibility status. If more than one plan is offered by
the employer, the dependent shall be enrolled in the health benefit
plan in which the obligor is enrolled. However, if more than one
plan is offered to the obligor, the plan selected shall provide
coverage which is accessible to the dependent.
3. The employer shall withhold from the employee's compensation,
the employee's share, if any, of premiums for the health benefit plan
in an amount that does not exceed the amount specified in the
national medical support notice or the amount specified in 15 U.S.C.
§ 1673(b) and which is consistent with federal law. The employer
shall forward the amount withheld to the insurer.
4. Within thirty days of receipt of an order that requires an
obligor to enroll a dependent in a health benefit plan, the obligor's
employer shall provide the following information, as applicable,
regarding the enrollment status of the dependent to the obligor, the
obligee, or other legal custodian of the child, and the department:
a. That the dependent has been enrolled in a health benefit plan.
b. That the dependent is not eligible for enrollment and the
reasons that the dependent is not eligible to be enrolled.
c. That the order has been forwarded to the insurer and a
determination of eligibility for enrollment has not been made.
5. If the dependent has been enrolled in a health benefit plan,
all of the following information shall be provided:
a. The name of the insurer providing the health benefit plan.
b. The dependent's effective date of coverage.
c. The health benefit plan or account number.
d. The type of health benefit plan under which the dependent has
been enrolled, including whether dental, optical, office visits, and
prescription drugs are covered services. Additionally, the response
shall include a brief description of the applicable deductibles,
coinsurance, waiting periods for preexisting medical conditions, and
other significant terms or conditions which materially affect the
coverage.
6. An employer shall not revoke enrollment or eliminate coverage
for a dependent unless the employer is provided with satisfactory
written evidence that one of the following conditions exists:
a. A court or administrative order requiring coverage in a health
benefit plan is no longer in effect.
b. The dependent is eligible for or will be enrolled in a
comparable health benefit plan which will take effect no later than
the effective date of revocation of enrollment in the other plan.
c. The employer has eliminated dependent health coverage for all
employees.
Nothing in this section requires an employer to maintain coverage
for the dependent if the premiums are no longer being paid by the
obligor because the employer no longer owes compensation to the
obligor or because the obligor's employment has been terminated and
the obligor has not elected to continue coverage.
If an order requiring that the obligor provide coverage under a
health benefit plan for the dependent has been forwarded to the
obligor's employer pursuant to section 252E.4, and the obligor's
employment is terminated, the employer shall provide notice to the
obligee and the department within ten days of termination of the
obligor's employment.
7. If an order requiring that the obligor provide coverage under
a health benefit plan for the dependent has been forwarded to the
obligor's employer pursuant to section 252E.4, and the employer's
health benefit plan is terminated either in its entirety or with
respect to the obligor's insurance classification, or the employer
has changed its insurer or become self-insured, the employer shall
provide notice to the obligee or other legal custodian of the child
and the department ten days prior to the termination or change in
insurer.
8. If the department issues a national medical support notice to
an employer or plan administrator, all of the following shall apply:
a. The employer and plan administrator shall comply with the
provisions in the notice.
b. The employer and the plan administrator shall treat the notice
as an application by the department for health benefit plan coverage
for the dependent to the extent such application is required by the
health benefit plan.
c. If the obligor named in the notice is not an employee of the
employer, or if a health benefit plan is not offered or available to
the employee, the employer shall notify the department, as provided
in the notice, within twenty business days after the date of the
notice.
d. If a health benefit plan is offered or available to the
employee, the employer shall send the plan administrator's portion of
the notice to each appropriate plan administrator within twenty
business days after the date of the notice.
e. Upon notification from the plan administrator that the
dependent is enrolled, the employer shall either withhold and forward
the premiums as provided in subsection 3, or shall notify the
department that the enrollment cannot be completed due to limits
established for withholding as provided in subsection 3.
f. If the plan administrator notifies the employer that the
obligor is subject to a waiting period that expires more than ninety
days from the date of receipt of the notice by the plan administrator
or that the obligor is subject to a waiting period that is measured
in a manner other than the passage of time, the employer shall notify
the plan administrator when the obligor becomes eligible to enroll in
the plan and that the notice requires enrollment in the plan of the
dependent named in the notice.
g. The plan administrator shall enroll the dependent, and if
necessary to enrollment of the dependent shall also enroll the
obligor, in the plan selected in accordance with this paragraph. All
of the following shall apply to the selection of the plan:
(1) If the obligor is enrolled in a health benefit plan that
offers dependent coverage, that plan shall be selected.
(2) If the obligor is not enrolled in a plan or is not enrolled
in a plan that offers dependent coverage, and if only one plan with
dependent coverage is offered by the employer, that plan shall be
selected.
(3) If the obligor is not enrolled in a health benefit plan or is
not enrolled in a health benefit plan that offers dependent coverage,
if more than one plan with dependent coverage is offered by the
employer, and if the notice is issued by the child support recovery
unit, all of the following shall apply:
(a) If only one of the plans is accessible to the dependent, that
plan shall be selected. If none of the plans with dependent coverage
is accessible to the dependent, the unit shall amend or terminate the
notice.
(b) If more than one of the plans is accessible to the dependent,
the plan selected shall be the plan that provides basic coverage for
which the employee's share of the premium is lowest.
(c) If more than one of the plans is accessible to the dependent
but none of the accessible plans provides basic coverage, the plan
selected shall be a plan that is accessible and for which the
employee's share of the premium is lowest.
(d) If the employee's share of the premiums is the same under all
plans described in subparagraph (b) or (c), the unit shall attempt to
consult with the obligee when selecting the plan. If the obligee
does not respond within ten days of the unit's attempt, the unit
shall select a plan which shall be the plan's default option, if any,
or the plan with the lowest deductibles and copayment requirements.
(4) If the obligor is not enrolled in a health benefit plan or is
not enrolled in a health benefit plan that offers dependent coverage,
if more than one plan with dependent coverage is offered by the
employer, and if the notice is issued by the child support
enforcement agency of another state, that agency shall select the
plan as provided in paragraph "h", subparagraph (3).
h. Within forty business days after the date of the notice, the
plan administrator shall do all of the following as directed by the
notice:
(1) Complete the appropriate portion of the notice and return the
portion to the department.
(2) If the dependent is or is to be enrolled, notify the obligor,
the obligee, and the child and furnish the obligee with necessary
information. Provide the child support recovery unit with the type
of health benefit plan under which the dependent has been enrolled,
including whether dental, optical, office visits, and prescription
drugs are covered services.
(3) If more than one health benefit plan is available to the
obligor and the obligor is not enrolled, forward plan descriptions
and documents to the department and enroll the dependent, and if
necessary the obligor, in the plan selected by the department or in
any default option if the plan administrator has not received a
selection from the department within twenty business days of the date
the plan administrator returned the national medical support notice
response to the department.
(4) If the obligor is subject to a waiting period that expires
more than ninety days from the date of receipt of the notice by the
plan administrator or if the obligor has not completed a waiting
period that is measured in a manner other than the passage of time,
notify the employer, the department, the obligor, and the obligee.
Upon satisfaction of the period or requirement, complete the
enrollment.
(5) Upon completion of the enrollment, notify the employer for a
determination of whether the necessary employee share of the premium
is available.
(6) If the plan administrator is subject to the federal Employee
Retirement Income Security Act, as codified in 29 U.S.C. § 1169, or
is subject to the federal Child Support Performance and Incentive Act
of 1998, Pub. L. No. 105-200, § 401, subsection (e) or (f), and the
plan administrator determines the notice does not constitute a
qualified medical child support order, complete and send the response
to the department and notify the obligor, the obligee, and the child
of the specific reason for the determination.
9. This chapter does not preclude the exchange of required
information between the department and employers or insurers through
electronic data transfer.
90 Acts, ch 1224, §29; 94 Acts, ch 1171, §27; 2002 Acts, ch 1018,
§6, 7
Referred to in § 252E.8
252E.6 DURATION OF HEALTH BENEFIT PLAN COVERAGE.
1. A child is eligible for medical support for the duration of
the obligor's child support obligation. However, the child's
eligibility for coverage under a health benefit plan shall be
governed by all applicable plan provisions including, but not limited
to, eligibility and insurability standards.
2. For cases for which services are being provided pursuant to
chapter 252B, the department shall notify the employer when there is
no longer a current order for medical support in effect for which the
department is responsible. However, termination of medical support
ordered pursuant to section 252E.3 shall be governed by the insurer's
health benefit plan provisions for termination and by applicable
federal law.
90 Acts, ch 1224, §30; 2002 Acts, ch 1018, §8
252E.6A MOTION TO QUASH.
1. An obligor may move to quash the order to the employer under
section 252E.4 by following the same procedures and alleging a
mistake of a fact as provided in section 252D.31 or as provided in
subsection 2. If the unit is enforcing an income withholding order
and a medical support order simultaneously, any challenge to the
income withholding order and medical support enforcement shall be
filed and heard simultaneously.
2. The obligor may allege as a mistake of fact an error in the
availability of dependent coverage under the health benefit plan
because the coverage is not accessible to the dependent. Even if the
plan is not accessible as defined in section 252E.1, the court may
determine that the plan is substantially accessible if the obligee
demonstrates that the dependent may receive a benefit under the plan.
Section 252K.316 relating to evidence and procedure shall apply to
the court proceeding.
3. The employer shall comply with the requirements of this
chapter until the employer receives notice that a motion to quash has
been granted, or that the unit has amended or terminated the national
medical support notice.
97 Acts, ch 175, §75; 2002 Acts, ch 1018, §9
252E.7 INSURER AUTHORIZATION.
1. The entry of an order requiring a health benefit plan is
authorization for enrollment of the dependent if the dependent is
otherwise eligible to be enrolled. If the obligor fails to obtain
coverage for a dependent, the insurer shall accept the signature of
the obligee or other legal custodian of the child or of an employee
of the department on the application for enrollment of the dependent
under the health benefit plan. If the dependent is otherwise
eligible to be enrolled in the plan pursuant to the applicable terms
and conditions of the health benefit plan and the standard enrollment
guidelines of the insurer, the insurer shall allow enrollment of the
dependent at any time, notwithstanding any enrollment season
restrictions.
2. An insurer shall not deny enrollment of a child under the
health benefit plan of the obligor based on any of the following:
a. The child was born out of wedlock.
b. The child is not claimed as a dependent on the obligor's
federal income tax form.
c. The child does not reside with the obligor or in the insurer's
service area.
3. For purposes of processing claims for payment, the insurer
shall accept the signature of the obligee or other legal custodian of
the child or of an employee of the department as valid authorization
for purposes of processing any medical expense claims on behalf of
the dependent for payment or reimbursement of medical services
rendered to the dependent.
4. The insurer shall have immunity from any liability, civil or
criminal, which might otherwise be incurred or imposed for actions
taken in implementing this section including, but not limited to, the
insurer's release of any information, or the payment of any claims
for services by the insurer, or the insurer's acceptance of
applications for enrollment of the dependent and medical expense
claims for the dependent which are signed by the obligee or an
employee of the department pursuant to this section.
5. If a dependent has coverage under the health benefit plan of
and through the insurer of the obligor, the insurer shall make
payment directly to the obligee, the provider, or the department for
claims submitted by the obligee, by the provider with the obligee's
approval, or by the department.
6. Payments remitted to the obligor by the insurer for services
received by the dependent shall be recoverable by the obligee or the
department from the obligor if not properly paid by the obligor to
the provider or the obligee.
90 Acts, ch 1224, §31; 94 Acts, ch 1171, §28
252E.8 RELEASES OF INFORMATION.
1. If an order for coverage under a health benefit plan has been
forwarded pursuant to section 252E.5, the obligor's employer or
insurer shall release to the obligee or other legal custodian of the
child or the department, upon receiving a written request, the
information necessary to complete an application, to file a claim for
medical expenses of the dependent or to create a qualified medical
child support order pursuant to section 252E.2, subsection 2.
2. The employer or insurer shall make available to the obligee or
the department any necessary claim forms or enrollment membership
cards if required to obtain services.
3. The obligor's employer and insurer shall have immunity from
any liability, civil or criminal, which might otherwise be incurred
or imposed for any information released by such employer or insurer
pursuant to this chapter.
4. The department may release to the obligor's employer or
insurer or to the obligee information necessary to obtain, enforce,
and collect medical support.
90 Acts, ch 1224, §32; 94 Acts, ch 1171, §29
252E.9 RESPONSIBILITIES OF THE OBLIGOR.
1. For cases for which services are being provided pursuant to
chapter 252B, an obligor who fails to maintain medical support for
the benefit of the dependent as ordered shall be liable to the
obligee or the department for any medical expenses incurred from the
date of the court order. Proof of failure to maintain medical
support constitutes a showing of increased need and provides a basis
for the establishment of a monetary amount for medical support.
2. For cases for which services are being provided pursuant to
chapter 252B, the obligor shall notify the obligee and the department
within ten days of a change in the terms or conditions of coverage
under a health benefit plan. Such changes may include, but are not
limited to, a change in deductibles, coinsurance, preadmission
notification requirements, coverage for dental, optical, office
visits, prescription drugs, inpatient and outpatient hospitalization,
and any other changes which materially affect the coverage. Costs
incurred by the obligee or the department as a result of the
obligor's failure to provide notification as required are recoverable
from the obligor.
90 Acts, ch 1224, §33
252E.10 RESPONSIBILITY OF THE DEPARTMENT.
For cases for which services are being provided pursuant to
chapter 252B, the department shall take steps required by federal
regulations to implement and enforce an order for medical support.
90 Acts, ch 1224, §34
252E.11 ASSIGNMENT.
If medical assistance is provided by the department to a dependent
pursuant to chapter 249A, rights to medical support payments are
assigned to the department.
90 Acts, ch 1224, §35; 93 Acts, ch 78, §23
Referred to in § 598.21C
252E.12 ENFORCEMENT.
For the purposes of enforcement pursuant to chapter 252B, medical
support may be reduced to a dollar amount and may be collected
through the same remedies available for the collection and
enforcement of child support.
90 Acts, ch 1224, §36
252E.13 MODIFICATION OF SUPPORT ORDER.
1. Subject to 28 U.S.C. § 1738B, when high potential for
obtaining medical support exists, the obligee or the department may
petition for a modification of the obligor's support order to include
medical support or a monetary amount for medical support pursuant to
this chapter.
2. In addition, if a support order does not provide medical
support as defined in this chapter or equivalent medical support, the
department or a party to the order may seek a modification of the
order.
3. Subject to 28 U.S.C. § 1738B, the department may amend
information concerning the provisions regarding health benefits in a
court or administrative order if notice of the amendment is provided
to the court and to the parties to the order and if the amendment is
filed with the clerk of court.
90 Acts, ch 1224, §37; 94 Acts, ch 1171, §30; 96 Acts, ch 1141, §
25; 97 Acts, ch 175, § 76
252E.14 CHILD SUPPORT.
Unless the order specifies otherwise, medical support is not
included in the monetary amount of child support ordered to be paid
for orders entered on or after July 1, 1990.
90 Acts, ch 1224, §38
252E.15 RULEMAKING AUTHORITY -- COMPLIANCE.
The department shall adopt rules pursuant to chapter 17A to
implement this chapter for cases for which services are being
provided pursuant to chapter 252B. The department shall cooperate
with any agency of the state or federal government as may be
necessary to qualify for federal funds in conformity with provisions
of this chapter and Title IV-D of the federal Social Security Act.
90 Acts, ch 1224, §39
252E.16 SCOPE AND EFFECT.
1. The provisions of this chapter take effect July 1, 1990, for
all support orders entered pursuant to chapter 234, 252A, 252C, 598,
or 600B.
2. If an obligor was ordered to provide a health benefit plan or
insurance coverage under an order entered prior to July 1, 1990, but
did not comply with the order, insurers are not liable for medical
expenses incurred prior to July 1, 1990. However, such an order may
be implemented pursuant to the provisions of this chapter following
its enactment. This chapter shall not be implemented retroactively;
however, previous orders for medical support not otherwise complied
with may be reduced to a dollar amount and collected from the
obligor.
90 Acts, ch 1224, §40