ENROLLED
Senate Bill No. 522
(By Senators Wooton, Humphreys, Holliday, Dittmar,
Macnaughtan, Miller, Minard, Dalton, Ross,
Anderson and Claypole)
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[Passed March 11, 1994; in effect from passage.]
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AN ACT to amend and reenact section sixteen, article fifteen,
chapter thirty-three of the code of West Virginia, one
thousand nine hundred thirty-one, as amended; to further
amend said article by adding thereto two new sections,
designated sections eighteen and nineteen; to amend and
reenact section eleven, article sixteen of said chapter; to
further amend said article by adding two new sections,
designated sections thirteen and fourteen; to amend and
reenact section two, article sixteen-c of said chapter; to
further amend said article by adding a new section,
designated section five-a; to amend and reenact section
four, article twenty-four of said chapter; to amend and
reenact section six, article twenty-five of said chapter; to
amend and reenact section twenty-four, article twenty-five-a
of said chapter; and to amend and reenact section fifteen-a,
article two, chapter forty-eight of said code, all relating
to health coverage; coverage of children; coverage for
adopted children and children of divorced parents;
prohibiting denial of insurance coverage under certain
conditions; insurer's obligations to children, parents,
providers and state agencies; employer's obligations; equal
treatment of state agency; coordination of benefits with
medicaid; medical support enforcement; applying provisions
to certain policies and insurers; modifying domestic
relations sections regarding insurance for children of
divorced parents; providing remedies for noncompliance with
court orders requiring health care coverage; providing for
wage attachment by state agencies; and making related
technical changes.
Be it enacted by the Legislature of West Virginia:
That section sixteen, article fifteen, chapter thirty-three
of the code of West Virginia, one thousand nine hundred
thirty-one, as amended, be amended and reenacted; that said
article be further amended be adding thereto two new sections,
designated sections eighteen and nineteen; that section eleven,
article sixteen of said chapter be amended and reenacted; that
said article be further amended by adding thereto two new
sections, designated sections thirteen and fourteen; that section
two, article sixteen-c of said chapter be amended and reenacted;
that said article be further amended by adding thereto a new
section, designated section five-a; that section four, article
twenty-four of said chapter be amended and reenacted; that
section six, article twenty-five of said chapter be amended and
reenacted; that section twenty-four, article twenty-five-a of
said chapter be amended and reenacted; and that sectionfifteen-a, article two, chapter forty-eight of said code be
amended and reenacted, all to read as follows:
CHAPTER 33. INSURANCE.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-16. Policies not to exclude insured's children from
coverage; required services; coordination with other
insurance.
(a) An insurer issuing accident and sickness policies in
this state shall provide coverage for the child or children of
the insured without regard to the amount of child support ordered
to be paid or actually paid by the insured, if any, and without
regard to the fact that the insured may not have legal custody of
the child or children or that the child or children may not be
residing in the home of the insured.
(b) An insurer issuing accident and sickness policies in
this state shall provide benefits to dependent children placed
with participants or beneficiaries for adoption under the same
terms and conditions as apply to natural, dependent children of
participants and beneficiaries, irrespective of whether the
adoption has become final.
(c) An insurer shall not deny enrollment of a child under
the health plan of the child's parent on the grounds that:
(1) The child was born out of wedlock;
(2) The child is not claimed as a dependent on the parent's
federal tax return; or
(3) The child does not reside with the parent or in the
insurer's service area.
(d) Where a child has health coverage through an insurer ofa noncustodial parent the insurer shall:
(1) Provide such information to the custodial parent as may
be necessary for the child to obtain benefits through that
coverage;
(2) Permit the custodial parent, or the provider, with the
custodial parent's approval, to submit claims for covered
services without the approval of the noncustodial parent; and
(3) Make payments on claims submitted in accordance with
subdivision (2) of this subsection directly to the custodial
parent, the provider or the state medicaid agency:
Provided,
That upon payment to the custodial parent, the provider or the
state medicaid agency, the insurer's obligation to the
noncustodial parent under the policy with respect to the covered
child's claims shall be fully satisfied.
(e) Where 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, the insurer shall:
(1) Permit the parent to enroll, under the family coverage,
a child who is otherwise eligible for the coverage without regard
to any enrollment season restrictions;
(2) If the parent is enrolled but fails to make application
to obtain coverage for the child, enroll the child under family
coverage upon application of the child's other parent, the state
agency administering the medicaid program or the state agency
administering 42 U.S.C. §651 through §669, the child support
enforcement program; and
(3) Not disenroll or eliminate coverage of the child unless
the insurer is provided satisfactory written evidence that:
(A) The court or administrative order is no longer in
effect; or
(B) 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 disenrollment.
§33-15-18. Equal treatment of state agency.
An insurer may not impose requirements on a state agency,
which has been assigned the rights of an individual eligible for
medical assistance under medicaid 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.
§33-15-19. Coordination of benefits with medicaid.
Any health insurer, health maintenance organization as
defined in article twenty-five-a of this chapter or hospital and
medical service corporations as defined in article twenty-four of
this chapter is prohibited from considering the availability or
eligibility for medical assistance in this or any other state
under 42 U.S.C. §1396a, Section 1902 of the Social Security Act,
herein referred to as medicaid, when considering eligibility for
coverage or making payments under its plan for eligible
enrollees, subscribers, policyholders or certificateholders.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-11. Group policies not to exclude insured's children from
coverage; required services; coordination with other
insurance.
(a) An insurer issuing group accident and sickness policies
in this state shall provide coverage for the child or children of
each employee or member of the insured group without regard tothe amount of child support ordered to be paid or actually paid
by such employee or member, if any, and without regard to the
fact that the employee or member may not have legal custody of
the child or children or that the child or children may not be
residing in the home of the employee or member.
(b) An insurer issuing group accident and sickness policies
in this state shall provide benefits to dependent children placed
with participants or beneficiaries for adoption under the same
terms and conditions as apply to natural, dependent children of
participants and beneficiaries, irrespective of whether the
adoption has become final.
(c) An insurer shall not deny enrollment of a child under
the health plan of the child's parent on the grounds that:
(1) The child was born out of wedlock;
(2) The child is not claimed as a dependent on the parent's
federal tax return; or
(3) The child does not reside with the parent or in the
insurer's service area.
(d) Where a child has health coverage through an insurer of
a noncustodial parent the insurer shall:
(1) Provide such information to the custodial parent as may
be necessary for the child to obtain benefits through that
coverage;
(2) Permit the custodial parent, or the provider, with the
custodial parent's approval, to submit claims for covered
services without the approval of the noncustodial parent; and
(3) Make payments on claims submitted in accordance with
subdivision (2) of this subsection directly to the custodialparent, the provider or the state medicaid agency:
Provided,
That upon payment to the custodial parent, the provider or the
state medicaid agency the insurer's obligation to the
noncustodial parent under the policy with respect to the covered
child's claims shall be fully satisfied.
(e) Where a parent is required by court or administrative
order to provide health coverage for a child, and the parent is
eligible for family health coverage, the insurer shall:
(1) Permit the parent to enroll, under the family coverage,
a child who is otherwise eligible for the coverage without regard
to any enrollment season restrictions;
(2) If the parent is enrolled but fails to make application
to obtain coverage for the child, enroll the child under family
coverage upon application of the child's other parent, the state
agency administering the medicaid program or the state agency
administering 42 U.S.C. §651 through §669, the child support
enforcement program; and
(3) Not disenroll or eliminate coverage of the child unless
the insurer is provided satisfactory written evidence that:
(A) The court or administrative order is no longer in
effect; or
(B) 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 disenrollment.
§33-16-13. Equal treatment of state agency.
An insurer may not impose requirements on a state agency,
which has been assigned the rights of an individual eligible for
medical assistance under medicaid and covered for health benefitsfrom the insurer, that are different from requirements applicable
to an agent or assignee of any other individual so covered.
§33-16-14. Coordination of benefits with medicaid.
Any health insurer, including a group health plan, as
defined in 29 U.S.C. §1167, Section 607(1) of the Employee
Retirement Income Security Act of 1974, health maintenance
organization as defined in article twenty-five-a of this chapter
or hospital and medical service corporations as defined in
article twenty-four of this chapter is prohibited from
considering the availability or eligibility for medical
assistance in this or any other state under 42 U.S.C. §1396a,
Section 1902 of the Social Security Act herein referred to as
medicaid, when considering eligibility for coverage or making
payments under its plan for eligible enrollees, subscribers,
policyholders or certificateholders.
ARTICLE 16C. EMPLOYER GROUP ACCIDENT AND SICKNESS INSURANCE
POLICIES.
§33-16C-2. Definitions.
As used in this article:
(a) "Basic policy" means a group accident and sickness
insurance contract for medical, surgical or hospital care that is
required to contain only those minimum benefits and coverages
mandated by this article, but which may contain other benefits
and coverages which have been approved by the insurance
commissioner.
(b) "Commissioner" means the insurance commissioner of West
Virginia.
(c) "Department" means the department of insurance.
(d) "Eligible employee" means an employee who is employed by
the employer for an average of at least twenty hours per week;
includes individuals who are sole proprietors, general partners
and limited partners; and includes individuals who either work or
reside in this state.
(e) "Eligible employer" means a corporation, partnership or
proprietorship which has done business in this state for at least
one year and has not offered health insurance to all of its
employees within the twelve months preceding its application for
a basic policy as defined by this section.
(f) "Family member" means an eligible employee's spouse and
any dependent child or stepchild under the age of eighteen or
under age twenty-three if a full-time student at an accredited
school: Provided, That the spouse, child or stepchild is not
eligible for medicare.
(g) "Insurer" means any of the following entities that holds
a valid certificate of authority from the commissioner: An
insurance company authorized to transact accident and sickness
insurance; a hospital service corporation, medical service
corporation or health service corporation organized pursuant to
article twenty-four of this chapter; a health care corporation
organized pursuant to article twenty-five of this chapter; or a
health maintenance organization organized pursuant to article
twenty-five-a of this chapter.
(h) "Premium" means the consideration for insurance, by
whatever name called.
§33-16C-5a. Policies not to exclude insured's children from
coverage; required services.
(a) Each basic policy issued pursuant to this article shall
provide coverage for the child or children of each employee or
member of the insured group without regard to the amount of child
support ordered to be paid or actually paid by such employee or
member, if any, and without regard to the fact that the employee
or member may not have legal custody of the child or children or
that the child or children may not be residing in the home of the
employee or member.
(b) Each basic policy issued pursuant to this article shall
provide benefits to dependent children placed with participants
or beneficiaries for adoption under the same terms and conditions
as apply to natural, dependent children of participants and
beneficiaries, irrespective of whether the adoption has become
final.
(c) An insurer shall not deny enrollment of a child under
the health plan of the child's parent on the grounds that:
(1) The child was born out of wedlock;
(2) The child is not claimed as a dependent on the parent's
federal tax return; or
(3) The child does not reside with the parent or in the
insurer's service area.
(d) Where a child has health coverage through an insurer of
a noncustodial parent the insurer shall:
(1) Provide such information to the custodial parent as may
be necessary for the child to obtain benefits through that
coverage;
(2) Permit the custodial parent, or the provider, with the
custodial parent's approval, to submit claims for coveredservices without the approval of the noncustodial parent; and
(3) Make payments on claims submitted in accordance with
subdivision (2) of this subsection directly to the custodial
parent, the provider or the state medicaid agency:
Provided,
That upon payment to the custodial parent, the provider or the
state medicaid agency, the insurer's obligation to the
noncustodial parent under the policy with respect to the covered
child's claims shall be fully satisfied.
(e) Where a parent is required by court or administrative
order to provide health coverage for a child, and the parent is
eligible for family health coverage, the insurer shall:
(1) Permit the parent to enroll, under the family coverage,
a child who is otherwise eligible for the coverage without regard
to any enrollment season restrictions;
(2) If the parent is enrolled but fails to make application
to obtain coverage for the child, enroll the child under family
coverage upon application of the child's other parent, the state
agency administering the medicaid program or the state agency
administering 42 U.S.C §651 through §669, the child support
enforcement program; and
(3) Not disenroll or eliminate coverage of the child unless
the insurer is provided satisfactory written evidence that:
(A) The court or administrative order is no longer in
effect; or
(B) 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 disenrollment.
ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE
CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE
CORPORATIONS.
§33-24-4. Exemptions; applicability of insurance laws.
Every corporation defined in section two of this article is
hereby declared to be a scientific, nonprofit institution and
exempt from the payment of all property and other taxes. Every
corporation, to the same extent the provisions are applicable to
insurers transacting similar kinds of insurance and not
inconsistent with the provisions of this article, shall be
governed by and be subject to the provisions as hereinbelow
indicated, of the following articles of this chapter: Article
two (insurance commissioner), except that, under section nine of
said article, examinations shall be conducted at least once every
four years; article four (general provisions), except that
section sixteen of said article shall not be applicable thereto;
section thirty-four, article six (fee for form and rate filing);
article six-c (guaranteed loss ratio); article seven (assets and
liabilities); article eleven (unfair trade practices); article
twelve (agents, brokers and solicitors), except that the agent's
license fee shall be five dollars; section fourteen, article
fifteen (individual accident and sickness insurance); section
sixteen, article fifteen (coverage of children); section
eighteen, article fifteen (equal treatment of state agency);
section nineteen, article fifteen (coordination of benefits with
medicaid); article fifteen-a (long-term care insurance); section
three, article sixteen (required policy provisions); section
three-a, article sixteen (mental illness); section three-c,
article sixteen (group accident and sickness insurance); sectionthree-d, article sixteen (medicare supplement insurance); section
three-f, article sixteen (treatment of temporomandibular joint
disorder and craniomandibular disorder); section eleven, article
sixteen (coverage of children); section thirteen, article sixteen
(equal treatment of state agency); section fourteen, article
sixteen (coordination of benefits with medicaid); article
sixteen-a (group health insurance conversion); article sixteen-c
(small employer group policies); article sixteen-d (marketing and
rate practices for small employers); article twenty-six-a (West
Virginia life and health insurance guaranty association act),
after the first day of October, one thousand nine hundred ninety-
one; article twenty-seven (insurance holding company systems);
article twenty-eight (individual accident and sickness insurance
minimum standards); article thirty-three (annual audited
financial report); article thirty-four (administrative
supervision); article thirty-four-a (standards and commissioner's
authority for companies deemed to be in hazardous financial
condition); article thirty-five (criminal sanctions for failure
to report impairment); and article thirty-seven (managing general
agents); and no other provision of this chapter may apply to
these corporations unless specifically made applicable by the
provisions of this article. If, however, the corporation is
converted into a corporation organized for a pecuniary profit or
if it transacts business without having obtained a license as
required by section five of this article, it shall thereupon
forfeit its right to these exemptions.
ARTICLE 25. HEALTH CARE CORPORATIONS.
§33-25-6. Supervision and regulation by insurance commissioner;
exemption from insurance laws.
Corporations organized under this article are subject to
supervision and regulation of the insurance commissioner. The
corporations organized under this article, to the same extent
these provisions are applicable to insurers transacting similar
kinds of insurance and not inconsistent with the provisions of
this article, shall be governed by and be subject to the
provisions as hereinbelow indicated of the following articles of
this chapter: Article four (general provisions), except that
section sixteen of said article shall not be applicable thereto;
article six-c (guaranteed loss ratio); article seven (assets and
liabilities); article eight (investments); article ten
(rehabilitation and liquidation); section fourteen, article
fifteen (individual accident and sickness insurance); section
sixteen, article fifteen (coverage of children); section
eighteen, article fifteen (equal treatment of state agency);
section nineteen, article fifteen (coordination of benefits with
medicaid); section three, article sixteen (required policy
provisions); section eleven, article sixteen (coverage of
children); section thirteen, article sixteen (equal treatment of
state agency); section fourteen, article sixteen (coordination of
benefits with medicaid); article sixteen-a (group health
insurance conversion); article sixteen-c (small employer group
policies); article sixteen-d (marketing and rate practices for
small employers); article twenty-six-a (West Virginia life and
health insurance guaranty association act); article twenty-seven
(insurance holding company systems); article thirty-three (annual
audited financial report); article thirty-four-a (standards andcommissioner's authority for companies deemed to be in hazardous
financial condition); article thirty-five (criminal sanctions for
failure to report impairment); and article thirty-seven (managing
general agents); and no other provision of this chapter may apply
to these corporations unless specifically made applicable by the
provisions of this article.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-24. Statutory construction and relationship to other
laws.
(a) Except as otherwise provided in this article, provisions
of the insurance laws and provisions of hospital or medical
service corporation laws shall not be applicable to any health
maintenance organization granted a certificate of authority under
this article. This provision shall not apply to an insurer or
hospital or medical service corporation licensed and regulated
pursuant to the insurance laws or the hospital or medical service
corporation laws of this state except with respect to its health
maintenance corporation activities authorized and regulated
pursuant to this article.
(b) Factually accurate advertising or solicitation regarding
the range of services provided, the premiums and copayments
charged, the sites of services and hours of operation, and any
other quantifiable, nonprofessional aspects of its operation by
a health maintenance organization granted a certificate of
authority, or its representative shall not be construed to
violate any provision of law relating to solicitation or
advertising by health professions: Provided, That nothing
contained herein shall be construed as authorizing anysolicitation or advertising which identifies or refers to any
individual provider or makes any qualitative judgment concerning
any provider.
(c) Any health maintenance organization authorized under
this article shall not be deemed to be practicing medicine and
shall be exempt from the provision of chapter thirty of this
code, relating to the practice of medicine.
(d) The provisions of section fifteen, article four (general
provisions); article six-c (guaranteed loss ratio); article seven
(assets and liabilities); article eight (investments); section
fourteen, article fifteen (individual accident and sickness
insurance); section sixteen, article fifteen (coverage of
children); section eighteen, article fifteen (equal treatment of
state agency); section nineteen, article fifteen (coordination of
benefits with medicaid); article fifteen-b (uniform health care
administration act); section three, article sixteen (required
policy provisions); section three-f, article sixteen (treatment
of temporomandibular disorder and craniomandibular disorder);
section eleven, article sixteen (coverage of children); section
thirteen, article sixteen (equal treatment of state agency);
section fourteen, article sixteen (coordination of benefits with
medicaid); article sixteen-a (group health insurance conversion);
article sixteen-c (small employer group policies); article
sixteen-d (marketing and rate practices for small employers);
article twenty-seven (insurance holding company systems); article
thirty-four-a (standards and commissioner's authority for
companies deemed to be in hazardous financial condition); article
thirty-five (criminal sanctions for failure to reportimpairment); and article thirty-seven (managing general agents)
shall be applicable to any health maintenance organization
granted a certificate of authority under this article.
(e) Any long-term care insurance policy delivered or issued
for delivery in this state by a health maintenance organization
shall comply with the provisions of article fifteen-a of this
chapter.
CHAPTER 48. DOMESTIC RELATIONS.
ARTICLE 2. DIVORCE, ANNULMENT AND SEPARATE MAINTENANCE.
§48-2-15a. Medical support enforcement.
(a) For the purposes of this section:
(1) "Custodian for the children" means a parent, legal
guardian, committee or other third party appointed by court order
as custodian of child or children for whom child support is
ordered.
(2) "Obligated parent" means a natural or adoptive parent
who is required by agreement or order to pay for insurance
coverage and medical care, or some portion thereof, for his or
her child.
(3) "Insurance coverage" means coverage for medical, dental,
including orthodontic, optical, psychological, psychiatric or
other health care service.
(4) "Child" means a child to whom a duty of child support is
owed.
(5) "Medical care" means medical, dental, optical,
psychological, psychiatric or other health care service for
children in need of child support.
(6) "Insurer" means any company, health maintenanceorganization, self-funded group, multiple employer welfare
arrangement, hospital or medical services corporation, trust,
group health plan, as defined in 29 U.S.C. §1167, Section 607(1)
of the Employee Retirement Income Security Act of 1974 or other
entity which provides insurance coverage or offers a service
benefit plan.
(b) In every action to establish or modify an order which
requires the payment of child support, the court shall ascertain
the ability of each parent to provide medical care for the
children of the parties. In any temporary or final order
establishing an award of child support or any temporary or final
order modifying a prior order establishing an award of child
support, the court shall order one or more of the following:
(1) The court shall order either parent or both parents to
provide insurance coverage for a child, if such insurance
coverage is available to that parent on a group basis through an
employer or through an employee's union. If similar insurance
coverage is available to both parents, the court shall order the
child to be insured under the insurance coverage which provides
more comprehensive benefits. If such insurance coverage is not
available at the time of the entry of the order, the order shall
require that if such coverage thereafter becomes available to
either party, that party shall promptly notify the other party of
the availability of insurance coverage for the child.
(2) If the court finds that insurance coverage is not
available to either parent on a group basis through an employer,
multi-employer trust or employees' union, or that the group
insurer is not accessible to the parties, the court may ordereither parent or both parents to obtain insurance coverage which
is otherwise available at a reasonable cost.
(3) Based upon the respective ability of the parents to pay,
the court may order either parent or both parents to be liable
for reasonable and necessary medical care for a child. The court
shall specify the proportion of the medical care for which each
party shall be responsible.
(4) If insurance coverage is available, the court shall also
determine the amount of the annual deductible on insurance
coverage which is attributable to the children and designate the
proportion of the deductible which each party shall pay.
(5) The order shall require the obligor to continue to
provide the child advocate office with information as to his or
her employer's name and address and information as to the
availability of employer-related insurance programs providing
medical care coverage so long as the child continues to be
eligible to receive support.
(c) The cost of insurance coverage shall be considered by
the court in applying the child support guidelines provided for
in section eight, article two, chapter forty-eight-a of this
code.
(d) Within thirty days after the entry of an order requiring
the obligated parent to provide insurance coverage for the
children, that parent shall submit to the custodian for the child
written proof that the insurance has been obtained or that an
application for insurance has been made. Such proof of insurance
coverage shall consist of, at a minimum:
(1) The name of the insurer;
(2) The policy number;
(3) An insurance card;
(4) The address to which all claims should be mailed;
(5) A description of any restrictions on usage, such as
prior approval for hospital admission, and the manner in which to
obtain such approval;
(6) A description of all deductibles; and
(7) Five copies of claim forms.
(e) The custodian for the child shall send the insurer or
the obligated parent's employer the children's address and notice
that the custodian will be submitting claims on behalf of the
children. Upon receipt of such notice, or an order for insurance
coverage under this section, the obligated parent's employer,
multi-employer trust or union shall, upon the request of the
custodian for the child, release information on the coverage for
the children, including the name of the insurer.
(f) A copy of the court order for insurance coverage shall
not be provided to the obligated parent's employer or union or
the insurer unless ordered by the court, or unless:
(1) The obligated parent, within thirty days of receiving
effective notice of the court order, fails to provide to the
custodian for the child written proof that the insurance has been
obtained or that an application for insurance has been made;
(2) The custodian for the child serves written notice by
mail at the obligated parent's last known address of intention to
enforce the order requiring insurance coverage for the child; and
(3) The obligated parent fails within fifteen days after the
mailing of the notice to provide written proof to the custodianfor the child that the child has insurance coverage.
(g) (1) Upon service of the order requiring insurance
coverage for the children, the employer, multi-employer trust or
union shall enroll the child as a beneficiary in the group
insurance plan and withhold any required premium from the
obligated parent's income or wages.
(2) If more than one plan is offered by the employer, multi-
employer trust or union, the child shall be enrolled in the same
plan as the obligated parent at a reasonable cost.
(3) Insurance coverage for the child which is ordered
pursuant to the provisions of this section shall not be
terminated except as provided in subsection (j) of this section.
(h) Where a parent is required by a court or administrative
order to provide health coverage, which is available through an
employer doing business in this state, the employer is required:
(1) To permit the parent to enroll under family coverage any
child who is otherwise eligible for coverage without regard to
any enrollment season restrictions;
(2) If the parent is enrolled but fails to make application
to obtain coverage of the child, to enroll the child under family
coverage upon application by the child's other parent, by the
state agency administering the medicaid program or by the child
advocate office;
(3) Not to disenroll or eliminate coverage of any such child
unless the employer is provided satisfactory written evidence
that:
(A) The court or administrative order is no longer in
effect;
(B) The child is or will be enrolled in comparable coverage
which will take effect no later than the effective date of
disenrollment; or
(C) The employer has eliminated family health coverage for
all of its employees;
(4) To withhold from the employee's compensation the
employee's share, if any, of premiums for health coverage and to
pay this amount to the insurer:
Provided,
That the amount so
withheld may not exceed the maximum amount permitted to be
withheld under 15 U.S.C. §1673, Section 303(b) of the Consumer
Credit Protection Act.
(i) (1) The signature of the custodian for the child shall
constitute a valid authorization to the insurer for the purposes
of processing an insurance payment to the provider of medical
care for the child.
(2) No insurer, employer or multi-employer trust in this
state may refuse to honor a claim for a covered service when the
custodian for the child or the obligated parent submits proof of
payment for medical bills for the child.
(3) The insurer shall reimburse the custodian for the child
or the obligated parent who submits copies of medical bills for
the child with proof of payment.
(4) All insurers in this state shall comply with the
provisions of section sixteen, article fifteen, chapter
thirty-three of this code and section eleven, article sixteen of
said chapter and shall provide insurance coverage for the child
of a covered employee notwithstanding the amount of support
otherwise ordered by the court and regardless of the fact thatthe child may not be living in the home of the covered employee.
(j) When an order for insurance coverage for a child
pursuant to this section is in effect and the obligated parent's
employment is terminated, or the insurance coverage for the child
is denied, modified or terminated, the insurer shall in addition
to complying with the requirements of article sixteen-a, chapter
thirty-three of this code, within ten days after the notice of
change in coverage is sent to the covered employee, notify the
custodian for the child and provide an explanation of any
conversion privileges available from the insurer.
(k) A child of an obligated parent shall remain eligible for
insurance coverage until the child is emancipated or until the
insurer under the terms of the applicable insurance policy
terminates said child from coverage, whichever is later in time,
or until further order of the court.
(l) If the obligated parent fails to comply with the order
to provide insurance coverage for the child, the court shall:
(1) Hold the obligated parent in contempt for failing or
refusing to provide the insurance coverage, or for failing or
refusing to provide the information required in subsection (d) of
this section;
(2) Enter an order for a sum certain against the obligated
parent for the cost of medical care for the child, and any
insurance premiums paid or provided for the child during any
period in which the obligated parent failed to provide the
required coverage; and
(3) In the alternative, other enforcement remedies available
under sections two and three, article five, chapter forty-eight-aof this code, or otherwise available under law, may be used to
recover from the obligated parent the cost of medical care or
insurance coverage for the child.
(4) In addition to other remedies available under law, the
child advocate office may garnish the wages, salary or other
employment income of, and withhold amounts from state tax refunds
to any person who:
(A) Is required by court or administrative order to provide
coverage of the cost of health services to a child eligible for
medical assistance under medicaid; and
(B) Has received payment from a third party for the costs of
such services but has not used the payments to reimburse either
the other parent or guardian of the child or the provider of the
services, to the extent necessary to reimburse the state medicaid
agency for its costs:
Provided,
That claims for current and past
due child support shall take priority over these claims.
(m) Proof of failure to maintain court ordered insurance
coverage for the child constitutes a showing of substantial
change in circumstances or increased need pursuant to section
fifteen of this article, and provides a basis for modification of
the child support order.