QMCSO

Qualified Medical Child Support Order (QMCSO) Overview

What's a QMCSO?

A QMCSO is designed to provide health coverage to a child(ren) of an employee through his or her employer's group health plan. The QMCSO process occurs through the court system.

A medical child support order becomes qualified as a QMCSO if it satisfies the employer's legal and administrative qualification requirements.

The Employee Retirement Income Security Act of 1974 (ERISA) and the employer's group health plan guide the employer's QMCSO process.

A 1993 amendment to the Employee Retirement Income Security Act (ERISA) requires employer-sponsored group health plans to extend health care coverage to the children of a parent/employee who is divorced, separated, or never married when ordered to do so by state authorities. This compliance assistance guide explains these ERISA provisions and describes how to obligate a plan to cover a child.

Generally, a State court or agency may require an ERISA-covered health plan to provide health benefits coverage to children by issuing a medical child support order. The group health plan must determine whether the medical child support order is “qualified.” Such an order is referred to as a Qualified Medical Child Support Order (QMCSO). In addition, a State child support enforcement agency may obtain group health coverage for a child by issuing a National Medical Support Notice that the group health plan determines to be qualified.

Group health plan sponsors and administrators will find this information useful in understanding the rights and obligations of those involved in child support proceedings and those responsible for administering group health plans.(1)

The first section of this Compliance Assistance Guide … Qualified Medical Child Support Orders provides general questions and answers about Qualified Medical Child Support Orders. The second section answers questions about National Medical Support Notices and the role of State child support enforcement agencies in obtaining health care coverage on behalf of children. A final resource section lists additional resources that may provide useful information about ERISA and obtaining health care coverage and medical care for children.

SOME FAQ
Q1-1: What types of plans are subject to the qualified medical child support order (QMCSO) provisions?
The QMCSO provisions apply to “group health plans” subject to the Employee Retirement Income Security Act of 1974, as amended (ERISA). For this purpose a “group health plan” generally is a plan that:

Is sponsored by an employer or employee organization (or both) and provides “medical care” to employees, former employees or their families.

“Medical care” means amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of a disease; for the purpose of affecting any structure or function of the body; transportation primarily for or essential to such care or services; or for insurance covering such care or services.

ERISA does not apply to plans maintained by: Federal, State or local governments; churches; and employers solely for purposes of complying with applicable workers compensation or disability laws. However, provisions of the Child Support Performance and Incentive Act (CSPIA) of 1998 require church plans to comply with QMCSOs and National Medical Support Notices, and State and local government plans to comply with National Medical Support Notices.

[ERISA §§ 4(b), 609(a), and 607(1), § 213(d) of the Internal Revenue Code, § 401(f) of CSPIA]

Q1-2: What is a Qualified Medical Child Support Order (QMCSO)?
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 or assigns to an alternate recipient the right of a participant or beneficiary to receive benefits under a group health plan; and

Is recognized by the group health plan as “qualified” because it includes information and meets other requirements of the QMCSO provisions. (see Qs 1-6 and 1-7).

In addition, a properly completed National Medical Support Notice (see Section 2) must be treated as a QMCSO.

[ERISA § 609(a)(2), 609(a)(5)(C)]

Q1-3: What is a “medical child support order”?
A 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 a community property law) or certain other State laws relating to medical child support (see Q1-8); 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 the plan.

[ERISA § 609(a)(2), § 1908 of the Social Security Act]

U.S. Department of Labor

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