Qualified Medical Child Support Order (QMCSO) Administration Manual by tony3x

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									Qualified Medical Child Support Order (QMCSO)
Administration Manual



Contents
Topic                             Page

Background                          3
Definitions                         5
Review Process and Criteria         7
Correspondence Procedures          11
Other Considerations               13
Contact List                       15
QMCSO Forms and Letters            17




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Background




A Qualified Medical Child Support Order (QMCSO) is a document that specifies how health benefits
are to be provided to an eligible child through a participant’s group health plan. This order, decree, or
authorized state agency document must meet the requirements of Section 609(a) of the Employee
Retirement Income Security Act (ERISA). The Plan Administrator may delegate any or all of the
responsibility for determining compliance with ERISA and the administrative procedures to a
corporate department or to a third-party administrator.

The QMCSO Administration Manual provides the internal policies and procedures for processing
QMCSOs. This section dictates the flow of information internally and identifies communication
among all interested parties. This section also includes the sample forms and letters that will be used
when corresponding with participants, alternate recipients, and/or their designated representatives.
The information outlined in this manual is intended to provide a general understanding of the legal
processes and requirements concerning QMCSOs.




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Definitions




Alternate Recipient/ERISA Section 609(a)(2)(D)
Any child of a participant who is recognized under a medical support order as having a right to
enrollment under a group health plan with respect to such participant. “Child” includes the natural
child of the participant, the adopted child of a participant, or a child who has been placed with the
participant in anticipation of adoption. “Child” does not include the participant’s grandchildren,
stepchildren, or the children of the participant’s domestic partner.


Certified Copy
An order signed by the judge or state agency authority and contains an original seal or stamp of the
court or agency clerk indicating that the document is a copy of the original on file with the court or
agency.


Metaldyne Corporation Group Health Plans
The group health plans available to participants of Metaldyne Corporation (Metaldyne).


ERISA
The Employee Retirement Income Security Act of 1974, as amended.


Health
For purposes of the Administration Manual, the term “health” will include the following: medical,
dental and vision. The model language will require that each coverage sought for the alternate
recipient(s) be specifically named.


National Medical Support Notice (NMSN)
Effective March 27, 2001, ERISA recognizes a National Medical Support Notice (NMSN) issued
from an appropriate state agency as a QMCSO if the form is completed accurately. A National
Medical Support Notice (NMSN) includes two parts—Part A (“Notice to Withhold for Health Care
Coverage” and “Employer Response”) and Part B (“Medical Support Notice to Plan Administrator”
and “Plan Administrator Response”).


Participant
An employee or retiree of Metaldyne eligible for benefits under a company group health plan.



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Qualified Medical Child Support Order (QMCSO)
A Qualified Medical Child Support Order (QMCSO) is an official document that specifies how
health benefits are to be provided to an eligible child through the participant’s group health plan.
Refer to ERISA, Section 609(a).




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Review Process and Criteria




QMCSO Process Overview
• Within 15 business days of the identification of an order, receipt will be acknowledged and a status
  determination will be made by reviewing the order against the criteria. Notification will be sent to
  the Issuing Agency, participant, alternate recipient(s), alternate recipient’s representative, and
  attorneys of record, as appropriate.

   Note: If an NMSN is received, federal law requires Part A (if applicable) to be completed and
   returned to the Issuing Agency within 20 business days subsequent to the date of the Notice. It also
   requires Part B (if applicable) to be completed and returned to the Issuing Agency within
   40 business days subsequent to the date of the Notice.

• When the order is determined to be qualified, the Qualified Order Team will coordinate with the
  Metaldyne Benefits Service Center to ensure coverage for the alternate recipient(s), pursuant to the
  terms of the QMCSO.

• The Qualified Order Team will respond to written and phone inquiries regarding the medical child
  support order process.


ERISA Criteria
• For an order to be a QMCSO, the following items, as required under ERISA 609(a)(2) to (5), must
  be addressed within the order.

   Note: Effective March 27, 2001, ERISA recognizes an NMSN issued from an appropriate state
   agency as a QMCSO if the form is completed accurately.

    The order must recognize the existence of an alternate recipient’s right to health coverage under
     the participant’s health plan.

    The order must be made pursuant to a state or administrative court, or authorized state agency
     directive to provide health coverage.

    The order must relate to a claim for health coverage for an eligible child within the meaning of
     ERISA, Section 609(a). This may include the natural child of the participant, the adopted child
     of the participant, or a child placed with the participant in anticipation of adoption.

    The order must clearly specify the name and last known mailing address of the participant.

       Note: For administrative purposes, the participant’s Social Security number may be needed.


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    The order must clearly specify the name and last known mailing address of the alternate
     recipient(s) covered by the order. Alternatively, instead of the alternate recipient’s last known
     mailing address, the order may provide the name and address of the alternate recipient’s
     designated representative, state official, or political subdivision.

    The order must specify the type and form of coverage (i.e., medical, dental, vision) to be
     provided.

    The order must specify the period during which coverage is to apply. It may include a
     beginning and ending date or a manner in which to determine such dates.

    The order must not require the Plan to provide any type or form of benefit, or any option that is
     not otherwise provided to that participant under the provisions of the Plan.

    The order must not require the Plan to pay more for medical coverage than is provided to the
     participant under the provisions of the Plan.


Metaldyne Group Health Plan Criteria
• A court order that contains a judge’s signature/stamp must contain an original raised seal and/or
  stamp of the court or agency clerk indicating that the document is a copy of the original on file
  with the court.

    State agency orders or notices are an exception to the certification requirement. An order from
     a state agency meets the certification requirements, if the order:

       – Is on the form of the agency, as evidenced by any letterhead or other agency identification
         information on the form; or

       – Is submitted by the agency, as evidenced by a cover letter on agency stationary.

• Coverage for the alternate recipient(s) will begin on the date the order is qualified. The Plan will
  not cover medical expenses incurred by a potential alternate recipient until the Plan determines an
  order to be a QMCSO. If the order contains a specific begin date, the order will qualify, but the
  date will be disregarded and coverage will begin on the date the order is qualified.

• The alternate recipient’s(s’) date of birth must be provided to determine coverage eligibility. If the
  date of birth is not contained within the order, but provided by other means (attached
  birth certificate and/or already exists on the TBA System) the order will qualify. If the date of birth
  is not contained in the order, nor can it be found on the TBA System and/or by attached
  birth certificate, the order will be denied on the basis that the alternate recipient’s(s’) eligibility for
  coverage under the Plan could not be determined.

• If the order does not contain a specific coverage ending date, coverage will end per the provisions
  of the Plan for an eligible dependent.




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• If the order states that the alternate recipient(s) will be provided with “health” coverage, this will
  be interpreted to be consistent with the definition of “health” in the Definitions section of this
  document.

• If the order does not state the Plan to which it applies, these procedures will be followed:

    If the participant currently participates in a Metaldyne Group Health Plan, the alternate
     recipient(s) will be enrolled in the same coverage option as the participant.

    If the participant is currently not covered under the Metaldyne Group Health Plan, but is
     eligible for coverage under a Metaldyne Group Health Plan, the participant will be moved into
     a previously determined default coverage option that can cover both the participant and the
     alternate recipient(s). The Metaldyne Benefits Service Center will contact the participant and
     provide him or her with all other available coverage options that would cover both the
     participant and the alternate recipient(s). The participant will be allowed to change his or her
     coverage option within a time frame consistent with a family status change. If the participant
     fails to meet the deadline, the participant and the alternate recipient(s) will remain in the default
     coverage option.

    If the order is an NMSN and the participant is currently not covered under the Metaldyne
     Group Health Plan, but is eligible for coverage under a Metaldyne Group Health Plan, Part B
     will be completed with all available plan options for which the participant is eligible. It will
     then be returned to the Issuing Agency within 40 business days after the date of the NMSN. If
     the Issuing Agency does not reply with their choice of plans within 20 business days, the
     alternate recipient(s) and the participant will be enrolled in the Plan’s default option.

    When an NMSN is received and the participant is subject to a waiting period that expires more
     than 90 days from the date of receipt of the NMSN or has not completed a waiting period
     whose duration is determined by a measure other than the passage of time (e.g., the completion
     of a certain number of hours worked), Part B will be completed and returned to the Issuing
     Agency. The NMSN must then be kept on file until the period or requirements have been
     satisfied. At that time, the enrollment will be completed.

• If the order specifies a Metaldyne Group Health Plan other than the one in which the participant is
  currently enrolled, and the participant is eligible to participate in the Metaldyne Group Health Plan
  specified within the order, the participant’s coverage option will be changed to comply with the
  order. The participant’s consent is not required to change medical coverage as a result of a
  QMCSO.




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Addresses
• If a submitted order does not contain any addresses, and/or there is no cover letter attached to the
  order, the order will not be reviewed.

• If the order does not contain the address of the participant, the order will be denied unless we can
  satisfy one of the following exceptions:

    If the participant’s address is on the TBA System, use this address to satisfy the address
     requirement and also use it for notification purposes.

    If the participant’s address is not on the TBA System, we will review the cover letter or any
     other information submitted with the order for the participant’s address to satisfy the address
     requirement and to also use it for notification purposes.


Termination of Coverage
• To terminate QMCSO coverage before the QMCSO has been satisfied, a termination of QMCSO
  coverage notice/order must be submitted to the Qualified Order Team. This termination of
  QMCSO coverage notice/order must do the following:

    Contain one of the following: the full names(s) of the alternate recipient(s) whose QMCSO
     coverage is to be terminated and/or the case number that appears on the originating QMCSO.

    State that the originally submitted QMCSO is to be terminated.

• If the termination of QMCSO coverage notice/order meets the above requirements, the
  QMCSO coverage will be terminated effective the date the termination notice/order is reviewed
  regardless of any termination date provided within the termination notice/order.

   Note: If the alternate recipient(s) were voluntarily enrolled by the participant prior to the receipt
   of the QMCSO, the alternate recipient’s(s’) QMCSO status (only) will be dropped. The alternate
   recipient(s) will continue to receive coverage unless the participant decides, in the future, to
   voluntarily discontinue the coverage.




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Correspondence Procedures




• If the order is determined to be a QMCSO:

    The Qualified Order Team will send an MCSO Approval Notice to all interested parties
     (the participant, the alternate recipient(s), the alternate recipient’s(s’) representative, a
     state agency and any attorney, if appropriate) stating that the order is a QMCSO. The
     correspondence will include a copy of the procedures and a copy of the QMCSO.

    The Metaldyne Benefits Service Center will update the appropriate systems to reflect the
     participant’s coverage elections and to reflect that the participant is affected by a QMCSO
     regarding the named child(ren).

• If the MCSO is determined not to be a QMCSO, the Qualified Order Team will send an MCSO
  Denial Notice to all interested parties (the participant, the alternate recipient(s), the alternate
  recipient’s(s’) representative, a state agency and any attorney, if appropriate) stating the order is
  not a QMCSO. The correspondence will inform the parties of the issues that must be clarified in
  the order to satisfy the requirements of a QMCSO using the Issues List. The correspondence will
  include a copy of the procedures, the sample language, and a copy of the document that was
  originally submitted for review.

• If the termination of QMCSO coverage notice/order is accepted, the Qualified Order Team will
  send a Termination of QMCSO Coverage Approval Notice to all interested parties (the participant,
  the alternate recipient(s), the alternate recipient’s(s’) representative, a state agency and any
  attorney, if appropriate) stating that the termination notice was accepted. The Metaldyne Benefits
  Service Center will be instructed to drop the alternate recipient(s) from the participant’s coverage.

   Notes
   • If the alternate recipient(s) were voluntarily enrolled by the participant prior to the receipt of
     the QMCSO, the alternate recipient’s(s’) QMCSO status (only) will be dropped. The alternate
     recipient(s) will continue to receive coverage unless the participant decides, in the future, to
     voluntarily discontinue the coverage.

   • If, prior to the receipt of the QMCSO, the participant had originally opted out and/or waived his
     or her coverage but was forced into said coverage due to the QMCSO and then, subsequently,
     receives an acceptable QMCSO termination notice and the dependent(s) is dropped from
     coverage, the participant will be allowed to drop his or her coverage, provided that he or she
     contacts the Metaldyne Benefits Service Center within the time frame consistent with a qualified
     status change. If the participant fails to contact the Metaldyne Benefits Service Center within
     the time frame consistent with a qualified status change, he or she will be required to continue
     said coverage until the next annual enrollment for the following plan year.



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• If the termination of QMCSO coverage notice/order is not accepted, the Qualified Order Team will
  send a Termination of QMCSO Coverage Denial Notice to all interested parties (the participant,
  the alternate recipient(s), the alternate recipient’s(s’) representative, a state agency and any
  attorney, if appropriate), stating that the termination notice/order is not accepted. The
  correspondence will inform the parties of the issues that must be clarified in order for the
  termination notice/order to be accepted. The correspondence will include the Issues List, a copy of
  the termination of QMCSO coverage notice/order, and the procedures.

• Notification of the review determination will be sent to all interested parties (the participant,
  the alternate recipient(s), the alternate recipient’s(s’) representative, a state agency and any
  attorney, if appropriate) at the address provided within the order. Those parties whose addresses
  are not provided within the order (and/or not provided in an attached cover letter) will not receive
  notice.

   If any notification sent to the participant at the address contained in the order is returned as
   undeliverable, the notification will be re-sent to the participant at the current address contained on
   the TBA System (if different from the address contained in the order).




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Other Considerations




• An order must not state that a Metaldyne Group Health Plan will be required to pay more for the
  coverage of an alternate recipient(s) than it would pay for the coverage of a similarly situated
  dependent without the benefit of a QMCSO.

• Only a natural child of the participant, an adopted child of the participant, or a child placed with
  the participant in anticipation of adoption is eligible as an alternate recipient under a QMCSO. If a
  spouse, former spouse, stepchild, grandchild, or other dependent of the participant is named in an
  order as an alternate recipient, the order will not be qualified.

• Sample language will be provided, but it is the parties’ or parties’ attorneys’ responsibility to
  verify that the order complies with state domestic relations laws. The Qualified Order Team will
  not verify that the order is in compliance with state laws.

• A QMCSO may only be terminated upon the earlier of:

    The participant’s termination of employment or other loss of eligibility;

    Fulfillment of the QMCSO’s terms; or

    Further order of the court or authorized state agency.

• Only a court or an authorized state agency may modify a QMCSO. Written notification of the
  interested parties is not sufficient.

• If the order requires either the Plan, Metaldyne, or the Qualified Order Team to sign the order, the
  order will be denied and it will be requested that the signature line be deleted from the order.

• ERISA preempts state requirements. Therefore, state agency requests, by themselves, would be
  preempted unless the order was a QMCSO. As such, state agency requests not meeting the
  requirements of a QMCSO will not qualify.

• Metaldyne will resolve any appeals regarding a denial/qualification determination made by the
  Qualified Order Team. See the Contact List for specific appeals contacts.

• Any payments for health care services made by the Plan pursuant to a QMCSO for expenses paid
  by an alternate recipient or an alternate recipient’s custodial parent or legal guardian will be paid
  directly to the alternate recipient’s custodial parent, legal representative, benefit provider, or the
  applicable state agency.




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• In the event the participant’s coverage under the Metaldyne Group Health Plan is terminated prior
  to the expiration of the coverage period specified within the order, the coverage of the alternate
  recipient(s) will also terminate. The alternate recipient(s) will be notified if he or she is eligible to
  elect continuation coverage pursuant to the Consolidated Omnibus Reconciliation Act of 1986
  (COBRA). This continued coverage must be paid by the alternate recipient(s).

• The end of an alternate recipient’s coverage is a qualifying event to trigger COBRA.

• If a QMCSO/NMSN is received and it requires enrollment only if the monthly premium does not
  exceed a specified amount, the Qualified Order Team will contact the Metaldyne Benefits
  Service Center to obtain the participant’s monthly premium amount. If the monthly premium
  amount exceeds the specified amount, the order will be denied.

• If an order/state agency notice is received and it either contains confidential addresses and/or
  multiple case information, a copy of the order will not be sent with the determination notice. The
  notice will instruct the parties to contact the submitting state agency and/or other third-party
  submitter to obtain a copy of the order/state agency notice.




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Contact List




Metaldyne Contacts        Hewitt Associates’ Contacts

                          Mr. Peter Curtis
                          Hewitt Associates LLC
                          100 Half Day Road
                          Lincolnshire, IL 60069
                          Telephone: 847-295-5000
                          Fax: 847-883-9313
                          E-Mail: pete.curtis@hewitt.com

                          Ms. Anita Patel
                          Hewitt Associates LLC
                          100 Half Day Road
                          Lincolnshire, IL 60069
                          Telephone: 847-295-5000
                          Fax: 847-883-9313
                          E-Mail: anita.patel@hewitt.com




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QMCSO Forms and Letters




Correspondence Name                  Description

MCSO Approval Notice                 Used to notify interested person(s) that an order is qualified.

MCSO Denial Notice                   Used to notify interested person(s) that an order does not qualify.

NMSN Approval Notice                 Used to notify interested person(s) that the NMSN is qualified.

NMSN Denial Notice                   Used to notify interested person(s) that the NMSN does not qualify.

Approval Notice for Termination of   Used to notify interested person(s) that the notice/order to terminate
QMCSO Coverage                       QMCSO coverage was approved and coverage has been terminated.

Approval Notice for Termination of   Used to notify interested person(s) that the notice/order to terminate
QMCSO Status                         QMCSO coverage was approved, but to terminate QMCSO status only,
                                     in cases when the child was already voluntarily covered, prior to the
                                     receipt of the QMCSO.

Denial Notice for Termination of     Used to notify interested person(s) that the notice/order to terminate
QMCSO Coverage                       QMCSO coverage was denied.

Request for Information Notice       Used with Model Language and Procedures to provide requested
                                     information.




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                                                       Medical Child Support Order
                                                       Approval Notice

                                                       Date: 07/14/2004
                                                       Court File Number: «CaseID»
                                                       Participant: «PptFirstNameMI» «PptLastName»
                                                       Regarding: «Ar1»
                                                                    «Ars»
«Addressee»
«Address»




Enclosed is a copy of a medical child support order regarding the above-named case. We have determined
the order to be a Qualified Medical Child Support Order (QMCSO) as defined by the
Employee Retirement Income Security Act of 1974 (ERISA), as amended.

Also enclosed is a summary of our procedures. These procedures outline the medical child support order
determination and administration processes.

In accordance with the enclosed QMCSO, the above referenced child(ren) is currently receiving all health
insurance coverage available to the participant as specified within the order. Please note the coverage
became effective upon the date of this notice. The coverage will continue as specified until the earlier of
the receipt of an amended order, the order’s provisions are satisfied, or the participant and/or alternate
recipient(s) are no longer eligible for coverage under the plan. The participant will receive a confirmation
statement if the QMCSO caused a change in his or her coverage election.

We are notifying all interested parties in this case by providing them with a copy of this letter and its
enclosures.

If you have any questions regarding this QMCSO, please refer to the contact information in the enclosed
procedures for the telephone number, hours of operation, and facsimile number.

«Enclosure»
«CC»«CC1»
   «CC2»
   «CC3»
   «CC4»
   «CC5»




*0450071                  P           SSN          *
                                                      Medical Child Support Order
A                                                     Denial Notice

                                                      Date: 07/14/2004
                                                      Court File Number: «CaseID»
                                                      Participant: «PptFirstNameMI» «PptLastName»
                                                      Regarding: «Ar1»
                                                                   «Ars»
«Addressee»
«Address»




Enclosed is a copy of a medical child support order regarding the above-named case. This document does
not meet the requirements for a Qualified Medical Child Support Order (QMCSO) as defined by the
Employee Retirement Income Security Act of 1974 (ERISA), as amended.

Please refer to the enclosed Issues List for the specific reasons why this document is not considered a
QMCSO, as well as suggestions for amending the language.

We have also enclosed a copy of our procedures and sample language. This sample language has
previously been considered “qualified” provided the order is fully and accurately completed in
accordance with state domestic relations laws.

If you would like the plan to monitor and enforce medical coverage or to add a dependent child, a
QMCSO may be required under Section 609(a) of ERISA.

The plan will take no further action at this time. All future orders will be responded to in accordance with
the enclosed procedures. We are notifying all interested parties in this case by providing them with a copy
of this letter and its enclosures.

If you have any questions regarding this QMCSO, please refer to the contact information in the enclosed
procedures for the telephone number, hours of operation, and facsimile number.

«Enclosure»
«CC»«CC1»
   «CC2»
   «CC3»
   «CC4»
   «CC5»




*0450091                  P          SSN          *
                                                       Medical Child Support Order
A                                                      Denial Notice

                                                       Date: 07/14/2004
                                                       Participant: «PptFirstNameMI» «PptLastName»



Issues List
The document submitted does not meet the requirements of a Qualified Medical Child Support Order
(QMCSO) due to the following reason(s):

      The court order must contain a judge’s signature or stamp and must contain an original raised seal
      and/or stamp of the court or agency clerk indicating that the document is a copy of the original on
      file with the court.

      The alternate recipient(s) must be a child eligible for coverage under the Plan. This includes the
      participant’s child, the participant’s adopted child, or a child placed with the participant in
      anticipation of adoption. This does not include the participant’s spouse, former spouse, stepchild, or
      grandchild.

      The last known address of the participant must be stated within the order.

      The last known address(es) of the alternate recipient(s) must be stated within the order. In place of
      the alternate recipient’s address, the QMCSO may instead provide the name and address of a
      designated representative, state official, or political subdivision.

      The order must contain the alternate recipient’s(s’) full name.

      The alternate recipient’s(s’) date of birth must be provided to determine eligibility under the Plan. It
      can either be contained in the order and/or the alternate recipient’s(s’) birth certificate can also be
      submitted with the order.

      Please specify the coverage to be provided and/or the manner in which such type of coverage is to
      be determined.

      You may either state the specific types of coverage (i.e., medical, dental, vision, etc.) to be
      provided, or you may state the manner in which to determine such coverage. For example, language
      such as “the child is to be enrolled in the same type of coverage as the participant” or “the Plan’s
      default coverage” would be acceptable.

      The participant named in the document is not eligible for coverage under the company’s health
      plan. As such, a QMCSO is inapplicable in this situation.

      The named participant is not an employee of Metaldyne. As such, a QMCSO is not applicable.

      Please resubmit the order once the participant is eligible for coverage under the company’s health
      plan.

      Please resubmit a complete copy of the order. Pages appear to be missing.
                                                      Medical Child Support Order
A                                                     Denial Notice

                                                      Date: 07/14/2004
                                                      Participant: «PptFirstNameMI» «PptLastName»


      The document submitted for review is illegible. Please resubmit a legible copy of the document for
      review.




Although not required within the order, you may wish to make the following additions to the submitted
document:

      Please include the Social Security number of the participant in the order.

      Please include the Social Security number(s) of the alternate recipient(s) in the order. Although the
      Social Security number is not a qualification requirement, it is required before coverage can begin.

      Please include the name and mailing address of a designated representative(s) for the alternate
      recipient(s) who will receive copies of all correspondence relating to this matter.

Please make the changes as detailed in the marked statements and resubmit the document for review to
the address provided in the enclosed procedures.
                                                       National Medical Support Notice
A                                                      Approval Notice

                                                       Date: 07/14/2004
                                                       Court File Number: «CaseID»
                                                       Participant: «PptFirstNameMI» «PptLastName»
                                                       Regarding: «Ar1»
                                                                    «Ars»
«Addressee»
«Address»




Enclosed is a copy of a National Medical Support Notice (NMSN) regarding the above-named case. We
have determined the order to be a Qualified Medical Child Support Order (QMCSO) as defined by the
Employee Retirement Income Security Act of 1974 (ERISA), as amended.

Also enclosed is a summary of our procedures. These procedures outline the medical child support order
determination and administration processes.

In accordance with the enclosed NMSN, the above referenced child(ren) is currently receiving all health
insurance coverage available to the participant as specified within the order. Please note the coverage
became effective the date provided on the enclosed Part B Plan Administrator Response. The coverage
will continue as specified until the earlier of the receipt of an amended order, the order’s provisions are
satisfied, or the participant and/or the alternate recipient(s) are no longer eligible for coverage under the
plan. The participant will receive a confirmation statement if the QMCSO caused a change in his or her
coverage election.

We are notifying all interested parties in this case by providing them with a copy of this letter and its
enclosures.

If you have any questions regarding this NMSN, please refer to the contact information in the enclosed
procedures for the telephone number, hours of operation, and facsimile number.

«Enclosure»
«CC»«CC1»
   «CC2»
   «CC3»
   «CC4»
   «CC5»




*0450071                   P          SSN          *
                  PART B—PLAN ADMINISTRATOR RESPONSE
(To be completed and returned to the Issuing Agency within 40 business days after the date of
the Notice, or sooner if reasonable)
This Notice was received by the plan administrator on                       .

    1.   This Notice was determined to be a “qualified medical child support order,” on                     .
         Complete Response 2 or 3, and 4, if applicable.

    2.   The participant (employee) and alternate recipient(s) (child(ren)) are to be enrolled in the
         following family coverage.
              a. The child(ren) is/are currently enrolled in the plan as a dependent of the participant.
              b. There is only one type of coverage provided under the plan. The child(ren) is/are
                   included as dependents of the participant under the plan.
              c. The participant is enrolled in an option that is providing dependent coverage and the
                   child(ren) will be enrolled in the same option.
              d. The participant is enrolled in an option that permits dependent coverage that has not
                   been elected; dependent coverage will be provided.

   Coverage is effective as of       /     /       (includes waiting period of less than 90 days from
   date of receipt of this Notice). The child(ren) has/have been enrolled in the following option:
                                      . Any necessary withholding should commence if the employer
   determines that it is permitted under State and Federal withholding and/or prioritization limitations.

    3.   There is more than one option available under the plan and the participant is not enrolled.
         The Issuing Agency must select from the available options. Each child is to be included as a
         dependent under one of the available options that provide family coverage. If the Issuing Agency
         does not reply within 20 business days of the date this Response is returned, the child(ren), and
         the participant, if necessary, will be enrolled in the plan’s default option, if any:
                                                      .

    4.   The participant is subject to a waiting period that expires     /     /       (more than
         90 days from the date of receipt of this Notice), or has not completed a waiting period which is
         determined by some measure other than the passage of time, such as the completion of a certain
         number of hours worked (describe here:                                        ). At the completion
         of the waiting period, the plan administrator will process the enrollment.

    5.   This Notice does not constitute a “qualified medical child support order” because:
              The name of the child(ren) or participant is unavailable.
              The mailing address of the child(ren) (or a substituted official) or participant is
              unavailable.
              The following child(ren) is/are at or above the age at which dependents are no longer
              eligible for coverage under the plan                                             (insert
              name(s) of child(ren)).


Representative: Metaldyne Benefits Service Center/Qualified Order Team

Telephone Number: 1-866-806-5115
                                        NMSN Supplement
Case Name                                                                  Case Number

Participant Name:



The following available coverages are in effect for the alternate recipient(s), as required by the
NMSN:

Insurance Carrier Name and Phone Number         Coverage Effective Date      Name of Persons Insured
                                          AVAILABLE PLAN OPTIONS
Insurance Company Name:                                                        Default Option:
Insurance Company Phone Number:




Type of Insurance Offered:
                  Medical;           Dental;    Vision;   Prescription Drug;          Mental Health;

                  Other (specify);

Insurance Company Name:                                                        Default Option:
Insurance Company Phone Number:




Type of Insurance Offered:
                  Medical;           Dental;    Vision;   Prescription Drug;          Mental Health;

                  Other (specify);

Insurance Company Name:                                                        Default Option:
Insurance Company Phone Number:




Type of Insurance Offered:
                  Medical;           Dental;    Vision;   Prescription Drug;          Mental Health;

                  Other (specify);

Insurance Company Name:                                                        Default Option:
Insurance Company Phone Number:




Type of Insurance Offered:
                  Medical;           Dental;    Vision;   Prescription Drug;          Mental Health;

                  Other (specify);

Insurance Company Name:                                                        Default Option:
Insurance Company Phone Number:




Type of Insurance Offered:
                  Medical;           Dental;    Vision;   Prescription Drug;          Mental Health;

                  Other (specify);
                                          AVAILABLE PLAN OPTIONS
Insurance Company Name:                                                        Default Option:
Insurance Company Phone Number:




Type of Insurance Offered:
                  Medical;           Dental;    Vision;   Prescription Drug;          Mental Health;

                  Other (specify);

Insurance Company Name:                                                        Default Option:
Insurance Company Phone Number:




Type of Insurance Offered:
                  Medical;           Dental;    Vision;   Prescription Drug;          Mental Health;

                  Other (specify);

Insurance Company Name:                                                        Default Option:
Insurance Company Phone Number:




Type of Insurance Offered:
                  Medical;           Dental;    Vision;   Prescription Drug;          Mental Health;

                  Other (specify);

Insurance Company Name:                                                        Default Option:
Insurance Company Phone Number:




Type of Insurance Offered:
                  Medical;           Dental;    Vision;   Prescription Drug;          Mental Health;

                  Other (specify);

Insurance Company Name:                                                        Default Option:
Insurance Company Phone Number:




Type of Insurance Offered:
                  Medical;           Dental;    Vision;   Prescription Drug;          Mental Health;

                  Other (specify);
                                                      National Medical Support Notice
A                                                     Denial Notice

                                                      Date: 07/14/2004
                                                      Court File Number: «CaseID»
                                                      Participant: «PptFirstNameMI» «PptLastName»
                                                      Regarding: «Ar1»
                                                                   «Ars»
«Addressee»
«Address»




Enclosed is a copy of a National Medical Support Notice (NMSN) regarding the above-named case. This
document does not meet the requirements for a Qualified Medical Child Support Order (QMCSO) as
defined by the Employee Retirement Income Security Act of 1974, as amended (ERISA).

Please refer to the enclosures for the specific reasons why this document is not considered a QMCSO. We
have also enclosed a copy of our procedures for your reference.

The plan will take no further action at this time. All future orders will be responded to in accordance with
the enclosed procedures. We are notifying all interested parties in this case by providing them with a copy
of this letter and its enclosures.

If you have any questions regarding this NMSN, please refer to the contact information in the enclosed
procedures for the telephone number, hours of operation, and facsimile number.

«Enclosure»
«CC»«CC1»
   «CC2»
   «CC3»
   «CC4»
   «CC5»




*0450091                  P          SSN          *
                                    PART A—EMPLOYER RESPONSE
If either 1, 2, or 3 below applies, check the appropriate box and return this Part A to the Issuing Agency within
20 business days after the date of the Notice, or sooner if reasonable. NO OTHER ACTION IS NECESSARY. If
neither 1, 2, nor 3 applies, forward Part B to the appropriate plan administrator(s) within 20 business days after the
date of the Notice, or sooner if reasonable. Check number 4 and return this Part A to the Issuing Agency if the Plan
Administrator informs you that the child(ren) is/are enrolled in an option under the plan for which you have
determined that the employee contribution exceeds the amount that may be withheld from the employee’s income
due to State or Federal withholding limitations and/or prioritization.

    1.   Employer does not maintain or contribute to plans providing dependent or family health
         care coverage.

    2.   The employee is among a class of employees (for example, part-time or non-union) that are
         not eligible for family health coverage under any group health plan maintained by the
         employer or to which the employer contributes.

    3.   Health care coverage is not available because employee is no longer employed by the
         employer:

                    Date of termination:

                    Last known address:

                    Last known telephone number:

                    New employer (if known):

                    New employer address:

                    New employer telephone number:

    4.   State or Federal withholding limitations and/or prioritization prevent the withholding from
         the employee’s income of the amount required to obtain coverage under the terms of the
         plan.



Representative: Metaldyne Benefits Service Center/Qualified Order Team

Telephone Number: 1-866-806-5115
                          PART B—PLAN ADMINISTRATOR RESPONSE
(To be completed and returned to the Issuing Agency within 40 business days after the date of the Notice, or sooner
if reasonable)
This Notice was received by the plan administrator on                       .

    1.   This Notice was determined to be a “qualified medical child support order,” on                     .
         Complete Response 2 or 3, and 4, if applicable.

    2.   The participant (employee) and alternate recipient(s) (child(ren)) are to be enrolled in the
         following family coverage.
              a. The child(ren) is/are currently enrolled in the plan as a dependent of the participant.
              b. There is only one type of coverage provided under the plan. The child(ren) is/are
                   included as dependents of the participant under the plan.
              c. The participant is enrolled in an option that is providing dependent coverage and the
                   child(ren) will be enrolled in the same option.
              d. The participant is enrolled in an option that permits dependent coverage that has not
                   been elected; dependent coverage will be provided.

   Coverage is effective as of       /     /       (includes waiting period of less than 90 days from
   date of receipt of this Notice). The child(ren) has/have been enrolled in the following option:
                                      . Any necessary withholding should commence if the employer
   determines that it is permitted under State and Federal withholding and/or prioritization limitations.

    3.   There is more than one option available under the plan and the participant is not enrolled.
         The Issuing Agency must select from the available options. Each child is to be included as a
         dependent under one of the available options that provide family coverage. If the Issuing Agency
         does not reply within 20 business days of the date this Response is returned, the child(ren), and
         the participant, if necessary, will be enrolled in the plan’s default option, if any:
                                                      .

    4.   The participant is subject to a waiting period that expires     /     /       (more than
         90 days from the date of receipt of this Notice), or has not completed a waiting period which is
         determined by some measure other than the passage of time, such as the completion of a certain
         number of hours worked (describe here:                                        ). At the completion
         of the waiting period, the plan administrator will process the enrollment.

    5.   This Notice does not constitute a “qualified medical child support order” because:
              The name of the child(ren) or participant is unavailable.
              The mailing address of the child(ren) (or a substituted official) or participant is
              unavailable.
              The following child(ren) is/are at or above the age at which dependents are no longer
              eligible for coverage under the plan                                             (insert
              name(s) of child(ren)).


Representative: Metaldyne Benefits Service Center/Qualified Order Team

Telephone Number: 1-866-806-5115
                                                      National Medical Support Notice
A                                                     Denial Notice

                                                      Date: 07/14/2004
                                                      Participant: «PptFirstNameMI» «PptLastName»



Issues List
The document submitted does not meet the requirements of a National Medical Support Notice (NMSN)
due to the following reason(s):

     The alternate recipient(s) must be a child eligible for coverage under the Plan. This includes the
     participant’s child, the participant’s adopted child, or a child placed with the participant in
     anticipation of adoption. This does not include the participant’s spouse, former spouse, stepchild, or
     grandchild.

     The last known address of the participant must be stated within the order.

     The last known address(es) of the alternate recipient(s) must be stated within the order. In place of
     the alternate recipient’s address, the QMCSO may instead provide the name and address of a
     designated representative, state official, or political subdivision.

     The order must contain the alternate recipient’s(s’) full name.

     The alternate recipient’s(s’) date of birth must be provided to determine eligibility under the Plan. It
     can either be contained in the order and/or the alternate recipient’s(s’) birth certificate can also be
     submitted with the order.

     Please specify the coverage to be provided and/or the manner in which such type of coverage is to
     be determined.

     You may either state the specific types of coverage (i.e., medical, dental, vision, etc.) to be
     provided, or you may state the manner in which to determine such coverage. For example, language
     such as “the child is to be enrolled in the same type of coverage as the participant” or “the Plan’s
     default coverage” would be acceptable.

     The participant named in the document is not eligible for coverage under the company’s health
     plan. As such, a QMCSO is inapplicable in this situation.

     The named participant is not an employee of Metaldyne. As such, a QMCSO is not applicable.

     Please resubmit the order once the participant is eligible for coverage under the company’s health
     plan.

     Please resubmit a complete copy of the order. Pages appear to be missing.
                                                      National Medical Support Notice
A                                                     Denial Notice

                                                      Date: 07/14/2004
                                                      Participant: «PptFirstNameMI» «PptLastName»



      The document submitted for review is illegible. Please resubmit a legible copy of the document for
      review.




Although not required within the order, you may wish to make the following additions to the submitted
document:

      Please include the Social Security number of the participant in the order.

      Please include the Social Security number(s) of the alternate recipient(s) in the order. Although the
      Social Security number is not a qualification requirement, it is required before coverage can begin.

      Please include the name and mailing address of a designated representative(s) for the alternate
      recipient(s) who will receive copies of all correspondence relating to this matter.

Please make the changes as detailed in the marked statements and resubmit the document for review to
the address provided in the enclosed procedures.
                                                       Termination of QMCSO Coverage
A                                                      Approval Notice

                                                       Date: 07/14/2004
                                                       Court File Number: «CaseID»
                                                       Participant: «PptFirstNameMI» «PptLastName»
                                                       Regarding: «Ar1»
                                                                    «Ars»
«Addressee»
«Address»




Enclosed is a copy of a Termination of QMCSO Coverage Notice/Order regarding the above-named case.
Pursuant to said notice/order, the above alternate recipient’s(s’) Qualified Medical Child Support Order
(QMCSO) coverage has been terminated, effective the date of this notice.

We have enclosed a copy of QMCSO procedures that outline the medical child support order
determination and administrative processes.

We are notifying all interested parties in this case by providing them with a copy of this letter and its
enclosures.

If you have any questions regarding this termination notice/order, please refer to the contact information
in the enclosed procedures for the telephone number, hours of operation, and facsimile number.

«Enclosure»
«CC»«CC1»
   «CC2»
   «CC3»
   «CC4»
   «CC5»




*0450071                  P           SSN          *
                                                       Termination of QMCSO Status
A                                                      Approval Notice

                                                       Date: 07/14/2004
                                                       Court File Number: «CaseID»
                                                       Participant: «PptFirstNameMI» «PptLastName»
                                                       Regarding: «Ar1»
                                                                    «Ars»
«Addressee»
«Address»




Enclosed is a copy of a termination of QMCSO coverage notice/order regarding the above-named case.
Pursuant to said notice/order, the above-named alternate recipient’s(s’) Qualified Medical Child
Support Order (QMCSO) status (only) has been terminated effective the date of this notice. Please note
that because the above-named alternate recipient(s) was covered voluntarily, prior to the receipt of the
QMCSO, the above-named alternate recipient(s) will continue to be covered by the participant unless the
participant decides, in the future, to voluntarily discontinue the coverage.

Please refer to the summary of our QMCSO procedures used to make this determination. These
procedures outline the medical child support order determination and administrative processes.
We are notifying all interested parties in this case by providing them with a copy of this letter and its
enclosures.

If you have any questions regarding this termination notice/order, please refer to the contact information
in the enclosed procedures for the telephone number, hours of operation, and facsimile number.

«Enclosure»
«CC»«CC1»
   «CC2»
   «CC3»
   «CC4»
   «CC5»




*0450071                  P           SSN          *
                                                      Termination of QMCSO Coverage
A                                                     Denial Notice

                                                      Date: 07/14/2004
                                                      Court File Number: «CaseID»
                                                      Participant: «PptFirstNameMI» «PptLastName»
                                                      Regarding: «Ar1»
                                                                   «Ars»
«Addressee»
«Address»




Enclosed is a copy of a termination of QMCSO coverage notice/order regarding the above-named case.
Please note that the enclosed notice/order does not meet our requirements to terminate the
Qualified Medical Child Support Order (QMCSO) coverage for the alternate recipient(s) listed above.
Please refer to the enclosed Issues List for the specific reason(s) why this notice/order does not meet our
requirements, as well as suggestions for amending the language.

We have also enclosed a copy of QMCSO procedures that outline the medical child support order
determination and administrative processes.

The plan will take no further action at this time. All future orders will be responded to in accordance with
the enclosed procedures. We are notifying all interested parties in this case by providing them with a copy
of this letter and its enclosures.

If you have any questions regarding this termination notice/order, please refer to the contact information
in the enclosed procedures for the telephone number, hours of operation, and facsimile number.

«Enclosure»
«CC»«CC1»
   «CC2»
   «CC3»
   «CC4»
   «CC5»




*0450091                  P          SSN          *
                                                     Termination of QMCSO Coverage
A                                                    Denial Notice

                                                     Date: 07/14/2004
                                                     Participant: «PptFirstNameMI» «PptLastName»



Issues List
The document submitted does not meet Metaldyne’s requirements to terminate the Qualified Medical
Child Support Order (QMCSO) due to the following reason(s):

      The termination notice/order must contain a judge’s signature or stamp and must contain an
      original raised seal and/or stamp of the court or agency clerk indicating that the document is a copy
      of the original on file with the court.

      The termination notice/order does not contain one of the following; the full name(s) of the alternate
      recipient(s) whose QMCSO coverage is to be terminated and/or the case number that appears on
      the originating QMCSO.

      The document submitted for review is illegible. Please resubmit a legible copy of the document for
      review.




      Please resubmit a complete copy of the order. Pages appear to be missing.

      The termination notice/order does not specifically refer to the QMCSO originally submitted, stating
      that it is to be terminated.

Please make the changes as detailed in the marked statements and resubmit the document for review to
the address provided in the enclosed procedures.
                                                      Medical Child Support Order
A                                                     Request for Information Notice

                                                      Date: 07/14/2004
                                                      Court File Number: «CaseID»
                                                      Participant: «PptFirstNameMI» «PptLastName»
                                                      Regarding: «Ar1»
                                                                   «Ars»
«Addressee»
«Address»




The Qualified Order Team has received your request for information regarding a medical child support
order. Enclosed is a copy of model language that Metaldyne has previously considered to be “qualified”
provided the order is fully and accurately completed in accordance with state domestic relations laws.
Also enclosed is a summary of procedures that have been adopted by Metaldyne regarding medical child
support orders.

Please mail medical child support orders to:

    Metaldyne Benefits Service Center
    Attention: Qualified Order Team
    Post Office Box 1433
    Lincolnshire, IL 60069-1433

We will make a determination on the qualification of the order and notify all interested parties within
15 business days from the date the order is received.

Please be advised that the order may only create a right to benefits for which a participant or beneficiary
would not otherwise be eligible in the absence of a Qualified Medical Child Support Order (QMCSO).

If you have any questions regarding this notice, please refer to the contact information in the enclosed
procedures for the telephone number, hours of operation, and facsimile number.

«Enclosure»
«CC»«CC1»
   «CC2»
   «CC3»
   «CC4»
   «CC5»

								
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