40-5-810. Notice of intent to enroll -- order to enroll -- authorization to enroll and participate in health benefit plan -- rules. (1) When a parent is required by a medical support order to obtain a health benefit plan for a child, the parent may be served with a notice of intent to enroll the child in any plan available to that parent. The notice may be issued separately or may be combined with any other notice issued under this part.
(2) The notice must contain a statement of the:
(a) procedures to follow if the parent wishes to contest enrollment of a child in the plan;
(b) conditions under which enrollment will occur and that enrollment applies to all current and subsequent plans; and
(c) period of time within which the parent may file a request for a hearing to contest the enrollment.
(3) For notices issued by the department under this section, hearings must be contested cases under Title 2, chapter 4.
(4) The notice must be served upon the parent by certified mail or personally, including by acknowledgment of service.
(5) An order requiring enrollment of a child in a plan may be issued:
(a) at any time after the parent's time for filing a request for a hearing on the notice of intent to enroll has lapsed;
(b) as a result of a hearing that authorizes an order to enroll;
(c) upon identifying a plan that is available to the parent; or
(d) upon determining that the cost of the plan available to the parent is reasonable.
(6) An order requiring enrollment in a plan may be served on a plan administrator, an employer, or another individual or entity by certified mail, personally, including by acknowledgment of service, or by electronic service upon an entity that has entered into an agreement with the department to accept electronic service of an order under this part.
(7) A plan administrator shall enroll a child when given a medical support order or an order to enroll the child issued under this section, even if a parent fails to execute documents required by the plan. The parents, the department, and a third-party custodian may release to a plan provider, employer, union, or other group any information necessary to obtain or enforce medical support or to facilitate the preparation, submission, processing, verification, or payment of claims.
(8) The signature of either parent, of an authorized representative of the department, or of a third-party custodian or the receipt of an order to enroll the child issued under this section authorizes the plan to receive and process claims and exercise any available options for the continuation or extension.
(9) (a) The order to enroll the child must instruct the employer to:
(i) transfer the order to the plan administrator within 20 working days or by another date specified in the order;
(ii) notify the entity issuing the order of any lapse in insurance coverage or employment;
(iii) notify the entity issuing the order when the child is enrolled;
(iv) withhold any premiums from the parent's income and transfer the premiums to the plan; and
(v) not disenroll the child except in situations specified in the order.
(b) The order to enroll the child must instruct the plan administrator to, within 40 working days of the date of receipt of the order:
(i) take steps to cover the child, to notify the employer, and to provide verification of enrollment and a plan description to the department, parents, and any third-party custodian of the child; or
(ii) provide information to the entity issuing the order concerning why coverage is not available.
(10) The department may adopt rules in conformity with federal law establishing the priority of withholdings for financial support and medical support. Regardless of the priority of withholdings, the maximum amount withheld from the parent's wages or salary, including fees, may not exceed the maximum amount permitted under the federal Consumer Credit Protection Act, 15 U.S.C. 1673.
(11) An order to enroll may be modified or replaced at any time to add a child to or remove a child from a plan, consistent with the parent's medical support obligation.
(12) The department may terminate an order to enroll issued by the department when the department is no longer authorized to enforce the parent's medical support obligation, when the parent's medical support obligation is terminated, or when the department determines that the cost of the plan to the parent is not reasonable.
History: En. Sec. 10, Ch. 504, L. 1995; amd. Sec. 3, Ch. 211, L. 2001; amd. Sec. 7, Ch. 431, L. 2005.