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U.S. Code as of:
01/19/04
Section 1396g-1. Required laws relating to medical child support
(a) In general
The laws relating to medical child support, which a State is
required to have in effect under section 1396a(a)(60) of this
title, are as follows:
(1) A law that prohibits an insurer from denying enrollment of
a child under the health coverage of the child's parent on the
ground that -
(A) the child was born out of wedlock,
(B) the child is not claimed as a dependent on the parent's
Federal income tax return, or
(C) the child does not reside with the parent or in the
insurer's service area.
(2) In any case in which a parent is required by a court or
administrative order to provide health coverage for a child and
the parent is eligible for family health coverage through an
insurer, a law that requires such insurer -
(A) to permit such parent to enroll under such family
coverage any such child who is otherwise eligible for such
coverage (without regard to any enrollment season
restrictions);
(B) if such a parent is enrolled but fails to make
application to obtain coverage of such child, to enroll such
child under such family coverage upon application by the
child's other parent or by the State agency administering the
program under this subchapter or part D of subchapter IV of
this chapter; and
(C) not to disenroll (or eliminate coverage of) such a child
unless the insurer is provided satisfactory written evidence
that -
(i) such court or administrative order is no longer in
effect, or
(ii) the child is or will be enrolled in comparable health
coverage through another insurer which will take effect not
later than the effective date of such disenrollment.
(3) In any case in which a parent is required by a court or
administrative order to provide health coverage for a child and
the parent is eligible for family health coverage through an
employer doing business in the State, a law that requires such
employer -
(A) to permit such parent to enroll under such family
coverage any such child who is otherwise eligible for such
coverage (without regard to any enrollment season
restrictions);
(B) if such a parent is enrolled but fails to make
application to obtain coverage of such child, to enroll such
child under such family coverage upon application by the
child's other parent or by the State agency administering the
program under this subchapter or part D of subchapter IV of
this chapter; and
(C) not to disenroll (or eliminate coverage of) any such
child unless -
(i) the employer is provided satisfactory written evidence
that -
(I) such court or administrative order is no longer in
effect, or
(II) the child is or will be enrolled in comparable
health coverage which will take effect not later than the
effective date of such disenrollment, or
(ii) the employer has eliminated family health coverage for
all of its employees; and
(D) to withhold from such employee's compensation the
employee's share (if any) of premiums for health coverage
(except that the amount so withheld may not exceed the maximum
amount permitted to be withheld under section 1673(b) of title
15), and to pay such share of premiums to the insurer, except
that the Secretary may provide by regulation for appropriate
circumstances under which an employer may withhold less than
such employee's share of such premiums.
(4) A law that prohibits an insurer from imposing requirements
on a State agency, which has been assigned the rights of an
individual eligible for medical assistance under this subchapter
and covered for health benefits from the insurer, that are
different from requirements applicable to an agent or assignee of
any other individual so covered.
(5) A law that requires an insurer, in any case in which a
child has health coverage through the insurer of a noncustodial
parent -
(A) to provide such information to the custodial parent as
may be necessary for the child to obtain benefits through such
coverage;
(B) to permit the custodial parent (or provider, with the
custodial parent's approval) to submit claims for covered
services without the approval of the noncustodial parent; and
(C) to make payment on claims submitted in accordance with
subparagraph (B) directly to such custodial parent, the
provider, or the State agency.
(6) A law that permits the State agency under this subchapter
to garnish the wages, salary, or other employment income of, and
requires withholding amounts from State tax refunds to, any
person who -
(A) is required by court or administrative order to provide
coverage of the costs of health services to a child who is
eligible for medical assistance under this subchapter,
(B) has received payment from a third party for the costs of
such services to such child, but
(C) has not used such payments to reimburse, as appropriate,
either the other parent or guardian of such child or the
provider of such services,
to the extent necessary to reimburse the State agency for
expenditures for such costs under its plan under this subchapter,
but any claims for current or past-due child support shall take
priority over any such claims for the costs of such services.
(b) "Insurer" defined
For purposes of this section, the term "insurer" includes a group
health plan, as defined in section 1167(1) of title 29, a health
maintenance organization, and an entity offering a service benefit
plan.
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