SUBCHAPTER L—HEALTH INSURANCE PORTABILITY AND RENEWABILITY FOR by theleopardus

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									                                       SUBCHAPTER L—HEALTH INSURANCE PORTABILITY AND
                                            RENEWABILITY FOR GROUP HEALTH PLANS

                                  PART 2590—RULES AND REGULA-                                Subpart A—Continuation Cov-
                                    TIONS FOR GROUP HEALTH PLAN                                 erage,    Qualified Medical
                                    REQUIREMENTS                                                Child Support Orders, Cov-
                                                                                                erage for Adopted Children
                                  Subpart A—Continuation Coverage, Quali-
                                     fied Medical Child Support Orders,                      § 2590.609–1     [Reserved]
                                     Coverage for Adopted Children
                                                                                             § 2590.609–2 National Medical Support
                                  Sec.                                                            Notice.
                                  2590.609–1    [Reserved]                                      (a) This section promulgates the Na-
                                  2590.609–2    National Medical Support Notice.
                                                                                             tional Medical Support Notice (the No-
                                  Subpart B—Requirements Relating to Ac-                     tice), as mandated by section 401(b) of
                                     cess and Renewability of Coverage,                      the Child Support Performance and In-
                                     and Limitations on Preexisting Condi-                   centive Act of 1998 (Pub. L. 105–200). If
                                     tion Exclusion Periods                                  the Notice is appropriately completed
                                                                                             and satisfies paragraphs (3) and (4) of
                                  2590.701–1 Basis and scope.                                section 609(a) of the Employee Retire-
                                  2590.701–2 Definitions.                                    ment Income Security Act (ERISA),
                                  2590.701–3 Limitations on preexisting condi-               the Notice is deemed to be a qualified
                                      tion exclusion period.
                                                                                             medical child support order (QMCSO)
                                  2590.701–4 Rules relating to creditable cov-
                                      erage.                                                 pursuant to ERISA section 609(a)(5)(C).
                                  2590.701–5 Certification and disclosure of                 Section 609(a) of ERISA delineates the
                                      previous coverage.                                     rights and obligations of the alternate
                                  2590.701–6 Special enrollment periods.                     recipient (child), the participant, and
                                  2590.701–7 HMO affiliation period as alter-                the group health plan under a QMCSO.
                                      native to preexisting condition exclu-                 A copy of the Notice is available on the
                                      sion.                                                  Internet at http://www.dol.gov/ebsa.
                                  2590.702 Prohibiting discrimination against                   (b) For purposes of this section, a
                                      participants and beneficiaries based on a
                                      health factor.
                                                                                             plan administrator shall find that a
                                  2590.703 Guaranteed renewability in multi-                 Notice is appropriately completed if it
                                      employer plans and multiple employer                   contains the name of an Issuing Agen-
                                      welfare arrangements. [Reserved]                       cy, the name and mailing address (if
                                                                                             any) of an employee who is a partici-
                                           Subpart C—Other Requirements                      pant under the plan, the name and
                                                                                             mailing address of one or more alter-
                                  2590.711 Standards relating to benefits for
                                      mothers and newborns.                                  nate recipient(s) (child(ren) of the par-
                                  2590.712 Parity in the application of certain              ticipant) (or the name and address of a
                                      limits to mental health benefits.                      substituted official or agency which
                                                                                             has been substituted for the mailing
                                           Subpart D—General Provisions                      address of the alternate recipient(s)),
                                                                                             and identifies an underlying child sup-
                                  2590.731 Preemption; State flexibility; con-
                                      struction.
                                                                                             port order.
                                  2590.732 Special rules relating to group                      (c)(1) Under section 609(a)(3)(A) of
                                      health plans.                                          ERISA, in order to be qualified, a med-
                                  2590.734 Enforcement. [Reserved]                           ical child support order must clearly
                                  2590.736 Applicability dates.                              specify the name and the last known
                                    AUTHORITY: 29 U.S.C. 1027, 1059, 1135, 1169,             mailing address (if any) of the partici-
                                  1181–1183, 1185, 1185a, 1185b, 1191, 1191a, 1191b,         pant and the name and mailing address
                                  and 1191c, sec. 101 (g) Pub. L. 104–191, 101               of each alternate recipient covered by
                                  Stat. 1936; sec. 401(b) Pub. L. 105–200, 112               the order, except that, to the extent
                                  Stat. 645; Secretary of Labor’s Order No. 1–               provided in the order, the name and
                                  2003, 68 FR 5373, (Feb. 3, 2003).                          mailing address of an official of a State
                                    SOURCE: 62 FR 16941, Apr. 8, 1997, unless                or a political subdivision thereof may
                                  otherwise noted.                                           be substituted for the mailing address

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                                  § 2590.701–1                                                         29 CFR Ch. XXV (7–1–03 Edition)

                                  of any such alternate recipient. Sec-                      quirements of a State law described in
                                  tion 609(a)(3)(B) of ERISA requires a                      such section 1908.
                                  reasonable description of the type of                        (e) For the purposes of this section,
                                  coverage to be provided to each such                       an ‘‘Issuing Agency’’ is a State agency
                                  alternate recipient, or the manner in                      that administers the child support en-
                                  which such type of coverage is to be de-                   forcement program under Part D of
                                  termined. Section 609(a)(3)(C) of ERISA                    Title IV of the Social Security Act.
                                  requires that the order specify the pe-                    [65 FR 82142, Dec. 27, 2000]
                                  riod to which such order applies.
                                    (2) The Notice satisfies ERISA sec-
                                  tion 609(a)(3)(A) by including the nec-                    Subpart B—Requirements Relating
                                  essary identifying information de-                            to Access and Renewability
                                  scribed in § 2590.609–2(b).                                   of Coverage, and Limitations
                                    (3) The Notice satisfies ERISA sec-                         on Preexisting Condition Ex-
                                  tion 609(a)(3)(B) by having the Issuing                       clusion Periods
                                  Agency identify either the specific
                                  type of coverage or all available group                      SOURCE: 62 FR 16941, Apr. 8, 1997. Redesig-
                                  health coverage. If an employer re-                        nated at 65 FR 82142, Dec. 27, 2000, unless oth-
                                  ceives a Notice that does not designate                    erwise noted.
                                  either specific type(s) of coverage or all
                                  available coverage, the employer and                       § 2590.701–1 Basis and scope.
                                  plan administrator should assume that                         (a) Statutory basis. This subpart im-
                                  all are designated. The Notice further                     plements part 7 of subtitle B of title I
                                  satisfies ERISA section 609(a)(3)(B) by                    of the Employee Retirement Income
                                  instructing the plan administrator                         Security Act of 1974, as amended (here-
                                  that if a group health plan has mul-                       inafter ERISA or the Act).
                                  tiple options and the participant is not                      (b) Scope. A group health plan or
                                  enrolled, the Issuing Agency will make                     health insurance issuer offering group
                                  a selection after the Notice is quali-                     health insurance coverage may provide
                                  fied, and, if the Issuing Agency does                      greater rights to participants and bene-
                                  not respond within 20 days, the child                      ficiaries than those set forth in this
                                  will be enrolled under the plan’s de-                      subpart. This subpart A sets forth min-
                                  fault option (if any).                                     imum requirements for group health
                                    (4) Section 609(a)(3)(C) of ERISA is                     plans and health insurance issuers of-
                                  satisfied because the Notice specifies                     fering group health insurance coverage
                                  that the period of coverage may only                       concerning:
                                  end for the alternate recipient(s) when                       (1) Limitations on a preexisting con-
                                  similarly situated dependents are no                       dition exclusion period.
                                  longer eligible for coverage under the                        (2) Certificates and disclosure of pre-
                                  terms of the plan, or upon the occur-                      vious coverage.
                                  rence of certain specified events.                            (3) Rules relating to counting cred-
                                    (d)(1) Under ERISA section 609(a)(4),                    itable coverage.
                                  a qualified medical child support order                       (4) Special enrollment periods.
                                  may not require a plan to provide any                         (5) Use of an affiliation period by an
                                  type or form of benefit, or any option,                    HMO as an alternative to a preexisting
                                  not otherwise provided under the plan,                     condition exclusion.
                                  except to the extent necessary to meet
                                  the requirements of a law relating to                      § 2590.701–2 Definitions.
                                  medical child support described in sec-                       Unless otherwise provided, the defini-
                                  tion 1908 of the Social Security Act, 42                   tions in this section govern in applying
                                  U.S.C. 1396g–1.                                            the provisions of §§ 2590.701 through
                                    (2) The Notice satisfies the condi-                      2590.734.
                                  tions of ERISA section 609(a)(4) be-                          Affiliation period means a period of
                                  cause it requires the plan to provide to                   time that must expire before health in-
                                  an alternate recipient only those bene-                    surance coverage provided by an HMO
                                  fits that the plan provides to any de-                     becomes effective, and during which
                                  pendent of a participant who is en-                        the HMO is not required to provide
                                  rolled in the plan, and any other bene-                    benefits.
                                  fits that are necessary to meet the re-                       COBRA definitions:

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