In accordance with Section 609(a) of the Employee Retirement Income Security Act of 1974 ("ERISA"), the Group Health Insurance & Prescription Drug Plan and the Group Dental Insurance Plan must, as required by law, observe the terms of any qualified medical child support order.
A medical child support order ("Order") is any judgment, decree, or order (including approval of a settlement agreement) issued by a court to accomplish one of two purposes. An Order may be issued pursuant to a state domestic relations law and provides for child support or health benefit coverage with respect to a child of a participant under the Group Health Insurance & Prescription Drug Plan and/or Group Dental Insurance Plan (the "Plans"), and relates to benefits under such Plans. An Order may be issued to enforce a state law relating to medical child support with respect to a group health plan.
The Plans do not have to comply with an Order unless it is "qualified". For an Order to be qualified, it must satisfy the requirements of relevant sections of ERISA. A qualified Order is one which creates or recognizes the existence of an alternate recipient's right to, or assigns to an alternate recipient the right to, receive benefits for which a participant or beneficiary is eligible under the Plans.
The following procedures have been adopted by Franklin & Marshall College ("College"), as Plan Administrator, for the purpose of determining whether an Order complies with such requirements. These procedures will be furnished, upon receipt of an Order, to the persons specified in such Order as being entitled to payments under the Plans or, upon request, to any employee covered under the Plans, eligible spouse, or any interested party who may be entitled to receive benefits under the Plans. In addition, any such person may designate a representative to receive copies of these procedures and all other pertinent correspondence related to the Order by writing to Franklin & Marshall College, Attn: Human Resources, P.O. Box 3003, Lancaster, PA 17604-3003.
Notice of Receipt
Upon receipt of an Order, the College or its authorized designee shall notify, in writing, the Participant and each child subject to the Order of receipt of the Order. This notice to the Participant and child(ren) shall acknowledge receipt of the Order and include a copy of these procedures. Any child subject to the Order may designate a representative for receipt of copies of communications sent by the Plan Administrator in connection with the Order.
Specification of Entitlement
The Order must specify that it applies to benefits under the Plans.
The Order must include the name and last known mailing address of the Participant and of each child covered by the Order.
The Order must address several issues related to the payment of benefits:
1. The Order must provide a reasonable description of the type of coverage to be provided by the Plans to each child, or the manner in which the type of coverage is to be determined.
2. The Order must specify the period to which the Order applies.
3. The Order must specify each plan to which the Order applies.
The Order will not be qualified if it provides for any type or form of benefit or any other option not otherwise available under the Plans, except to the extent it is necessary to comply with the state medical child support laws.
The Plan Administrator will review any Order submitted to it and determine, in accordance with these procedures and within a reasonable period of time, whether the Order is qualified.
When the Plan Administrator determines whether an Order is qualified, it will appropriately notify all persons named in the Order, in writing, stating either that the Order is qualified or the reasons why the Order fails to be qualified. If none of such persons dispute, in writing, such determination within 60 days of such notification, such determination will be deemed to be final.
If the Order is qualified, the Plans will permit either parent to submit the appropriate enrollment forms. Each child who is required to be enrolled in the Plans as a result of a qualified medical child support order will be considered a Plan participant, and is entitled to receive a copy of the Summary Plan Description, summaries of Plan changes, and the Plan's Summary Annual Report. When a child is insured through the noncustodial parent, the Plans will provide the custodial parent information to enable the child to obtain benefits from the Plans and to permit the custodial parent to file benefit claims without the approval of the noncustodial parent. If reimbursement for health expenses paid by the child or custodial parent is required, payment will be made to the child or custodial parent.