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Your Dependent as Determined by a Qualified Medical Child Support Order (QMCSO) or a National Medical Support Notice (NMSN)

A child who does not meet the Plan’s eligibility requirements based upon the child’s relationship to the Member or the Member’s spouse may still qualify for coverage under the Plan if the right to coverage is provided in a QMCSO or in a properly completed NMSN and the child remains within the limiting age or qualifies as incapacitated. A QMCSO is a medical child support order that creates or recognizes the right of an “alternate recipient” to receive benefits for which a participant or beneficiary is eligible under a group health plan and the group health plan recognizes the order as “qualified” because it contains necessary information and meets other requirements which are necessary to qualify as a QMCSO. A properly completed NMSN may also qualify the child for coverage.

A Qualified Medical Child Support Order is a judgment, decree or order (including an approval of a property settlement) that:

  • Is made pursuant to State domestic relations law (including community property law) or certain other State laws relating to medical child support, and
  • Provides for child support or health benefit coverage for a child of a participant under a group health plan and relates to benefits under that plan.

There are various pieces of information which must be supplied to the Plan in order for the Plan to consider the child “qualified”. The QMCSO must include the following:

  • The name and last known mailing address of the participant and each alternate recipient, except that the order may substitute the name and mailing address of a State or local official for the mailing address of the alternate recipient;
  • A reasonable description of the type of health coverage to be provided to each alternate recipient (or the manner in which such coverage is to be determined);
  • The period to which the order applies;
  • An order may not require a plan to provide any type or form of benefit, or any option, not otherwise provided under the plan, except to the extent necessary to meet the requirements of certain State laws.

A QMCSO or a NMSN should be sent to MILA for review of its qualified status. MILA will act expeditiously and will respond to the participant and any required third parties regarding the status of the order and the coverage for the alternate recipients.