514C.9 Medical support — insurance requirements. 1. An insurer shall not deny coverage or enrollment of a child under the health plan of the obligor upon any of the following grounds: a. The child is born out of wedlock.b. The child is not claimed as a dependent on the obligor’s federal income tax return.c. The child does not reside with the obligor or in the insurer’s service area. This section shall not be construed to require a health maintenance organization regulated underchapter 514B to provide any services or benefits for treatment outside of the geographic areadescribed in its certificate of authority which would not be provided to a member outside ofthat geographic area pursuant to the terms of the health maintenance organization’s contract. 2. An insurer of an obligor providing health care coverage to the child for which the obligor is legally responsible to provide support shall do all of the following: a. Provide information to the obligee or other legal custodian of the child as necessary for the child to obtain benefits through the coverage of the insurer. b. Allow the obligee or other legal custodian of the child, or the provider with the approval of the obligee or hild as necessary for the child to obtain benefits through the coverage of the insurer. b. Allow the obligee or other legal custodian of the child, or the provider with the approval of the obligee or other legal custodian of the child, to submit claims for covered serviceswithout the approval of the obligor. c. Make payment on a claim submitted in paragraph 'b' directly to the obligee or other legal custodian of the child, the provider, or the state medical assistance agency forclaims submitted by the obligee or other legal custodian of the child, by the provider withthe approval of the obligee or other legal custodian of the child, or by the state medicalassistance agency. 3. If an obligor is required by a court order or administrative order to provide health coverage for a child and the obligor is eligible for dependent health coverage, the insurershall do all of the following: a. Allow the obligor to enroll under dependent coverage a child who is eligible for coverage pursuant to the applicable terms and conditions of the health benefit plan andthe standard enrollment guidelines of the insurer without regard to an enrollment seasonrestriction. b. ible for coverage pursuant to the applicable terms and conditions of the health benefit plan andthe standard enrollment guidelines of the insurer without regard to an enrollment seasonrestriction. b. Enroll a child who is eligible for coverage under the applicable terms and conditions of the health benefit plan and the standard enrollment guidelines of the insurer, withoutregard to any time of enrollment restriction, under dependent coverage upon application bythe obligee or other legal custodian of the child or by the department of health and humanservices in the event an obligor required by a court order or administrative order fails to applyfor coverage for the child. c. Maintain coverage and not cancel the child’s enrollment unless the insurer obtains satisfactory written evidence of any of the following: (1) The court order or administrative order is no longer in effect.(2) The child is eligible for or will enroll in comparable health coverage through an insurer which shall take effect not later than the effective date of the cancellation of enrollment ofthe original coverage. (3) The employer has eliminated dependent health coverage for its employees.(4) The obligor is no e effect not later than the effective date of the cancellation of enrollment ofthe original coverage. (3) The employer has eliminated dependent health coverage for its employees.(4) The obligor is no longer paying the required premium because the employer no longer owes the obligor compensation, or because the obligor’s employment has terminated and theobligor has not elected to continue coverage. 4. A group health plan shall establish reasonable procedures to determine whether a child is covered under a qualified medical child support order issued pursuant to chapter 252E.The procedures shall be in writing, provide for prompt notice of each person specified in themedical child support order as eligible to receive benefits under the group health plan uponreceipt by the plan of the medical child support order, and allow an obligee or other legalcustodian of the child under chapter 252E to designate a representative for receipt of copiesof notices in regard to the medical child support order that are sent to the obligee or otherlegal custodian of the child and the department of health and human services’ child supportservices. 5. iesof notices in regard to the medical child support order that are sent to the obligee or otherlegal custodian of the child and the department of health and human services’ child supportservices. 5. For purposes of this section, unless the context otherwise requires: Sat Dec 23 00:45:02 2023 Iowa Code 2024, Section 514C.9 (18, 1) §514C.9, SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES 2 a. 'Child' means a person, other than an obligee’s spouse or former spouse, who is recognized under a qualified medical child support order as having a right to enrollmentunder a group health plan as the obligor’s dependent. b. 'Court order' or 'administrative order' means a ruling by a court or administrative agency in regard to the support an obligor shall provide to the obligor’s child. c. 'Insurer' means an entity which offers a health benefit plan.d. 'Obligee' means an obligee as defined in section 252E.1.e. 'Obligor' means an obligor as defined in section 252E.1.f. 'Qualified medical child support order' means a child support order which creates or recognizes a child’s right to receive health benefits for which the child is eligible under a grouphealth benefit plan, describes or determines ort order' means a child support order which creates or recognizes a child’s right to receive health benefits for which the child is eligible under a grouphealth benefit plan, describes or determines the type of coverage to be provided, specifies thelength of time for which the order applies, and specifies the plan to which the order applies. 95 Acts, ch 185, §14; 2023 Acts, ch 19, §1198, 1199Subsection 3, paragraph b amendedSubsection 4 amended Sat Dec 23 00:45:02 2023 Iowa Code 2024, Section 514C.9 (18, 1)
Iowa Legal Code