29 U.S.C. § 1169 — Additional standards for group health

Page 566 TITLE 29—LABOR § 1168 1 So in original. Probably should be section ‘‘13623’’. see section 7862(c)(2)(C) of Pub. L. 101–239, set out as a note under section 4980B of Title 26, Internal Revenue Code. Pub. L. 101–239, title VII, § 7862(c)(6)(B), Dec. 19, 1989, 103 Stat. 2433, provided that: ‘‘Subparagraph (A) [re- pealing section 3011(b)(6) of Pub. L. 100–647, which amended this section] shall be effective as if included in the enactment of section 3011(b) of the Technical and Miscellaneous Revenue Act of 1988 [Pub. L. 100–647].’’ Amendment by section 7891(a)(1) of Pub. L. 101–239 ef- fective, except as otherwise provided, as if included in the provision of the Tax Reform Act of 1986, Pub. L. 99–514, to which such amendment relates, see section 7891(f) of Pub. L. 101–239, set out as a note under section 1002 of this title. Amendment by section 7891(d)(2)(B)(i) of Pub. L. 101–239 applicable with respect to plan years beginning on or after Jan. 1, 1990, see section 7891(d)(2)(C) of Pub. L. 101–239, set out as a note under section 4980B of Title 26, Internal Revenue Code. EFFECTIVE DATE OF 1988 AMENDMENT Amendment by Pub. L. 100–647 applicable to taxable years beginning after Dec. 31, 1988, but not applicable to any plan for any plan year to which section 162(k) of Title 26, Internal Revenue Code (as in effect on the day before Nov. 10, 1988) did not apply by reason of section 10001(e)(2) of Pub. L. 99–272, see section 3011(d) of Pub. L. 100–647, set out as a note under section 162 of Title 26. EFFECTIVE DATE OF 1986 AMENDMENTS Pub. L. 99–514, title XVIII, § 1895(d)(9)(B), Oct. 22, 1986, 100 Stat. 2940, provided that: ‘‘The amendment made by subparagraph (A) [amending this section] shall take ef- fect in the same manner and to the same extent as the amendments made by subsections (e) and (i) of section 1151 of this Act [amending sections 132 and 414 of Title 26, Internal Revenue Code, see section 1151(k) of Pub. L. 99–514, set out as an Effective Date note under section 89 of Title 26].’’ Amendment by section 1895(d)(8) of Pub. L. 99–514 ef- fective, except as otherwise provided, as if included in enactment of the Consolidated Omnibus Budget Rec- onciliation Act of 1985, Pub. L. 99–272, see section 1895(e) of Pub. L. 99–514, set out as a note under section 162 of Title 26. Amendment by Pub. L. 99–509 effective, except as oth- erwise provided, as if included in title X of the Consoli- dated Omnibus Budget Reconciliation Act of 1985, Pub. L. 99–272, see section 9501(e) of Pub. L. 99–509, set out as a note under section 162 of Title 26. PLAN AMENDMENTS NOT REQUIRED UNTIL JANUARY 1, 1989 For provisions directing that if any amendments made by subtitle A or subtitle C of title XI [§§ 1101–1147 and 1171–1177] or title XVIII [§§ 1800–1899A] of Pub. L. 99–514 require an amendment to any plan, such plan amendment shall not be required to be made before the first plan year beginning on or after Jan. 1, 1989, see section 1140 of Pub. L. 99–514, as amended, set out as a note under section 401 of Title 26, Internal Revenue Code. § 1168. Regulations The Secretary may prescribe regulations to carry out the provisions of this part. (Pub. L. 93–406, title I, § 608, as added Pub. L. 99–272, title X, § 10002(a), Apr. 7, 1986, 100 Stat. 231.) § 1169. Additional standards for group health plans (a) Group health plan coverage pursuant to med- ical child support orders (1) In general Each group health plan shall provide bene- fits in accordance with the applicable require- ments of any qualified medical child support order. A qualified medical child support order with respect to any participant or beneficiary shall be deemed to apply to each group health plan which has received such order, from which the participant or beneficiary is eligible to receive benefits, and with respect to which the requirements of paragraph (4) are met. (2) Definitions For purposes of this subsection— (A) Qualified medical child support order The term ‘‘qualified medical child support order’’ means a medical child support order— (i) which creates or recognizes the exist- ence of an alternate recipient’s right to, or assigns to an alternate recipient the right to, receive benefits for which a participant or beneficiary is eligible under a group health plan, and (ii) with respect to which the require- ments of paragraphs (3) and (4) are met. (B) Medical child support order The term ‘‘medical child support order’’ means any judgment, decree, or order (in- cluding approval of a settlement agreement) which— (i) provides for child support with re- spect to a child of a participant under a group health plan or provides for health benefit coverage to such a child, is made pursuant to a State domestic relations law (including a community property law), and relates to benefits under such plan, or (ii) is made pursuant to a law relating to medical child support described in section 1908 of the Social Security Act [42 U.S.C. 1396g–1] (as added by section 13822 1 of the Omnibus Budget Reconciliation Act of 1993) with respect to a group health plan, if such judgment, decree, or order (I) is issued by a court of competent jurisdiction or (II) is issued through an administrative process established under State law and has the force and effect of law under applicable State law. For purposes of this subpara- graph, an administrative notice which is issued pursuant to an administrative process referred to in subclause (II) of the preceding sentence and which has the effect of an order described in clause (i) or (ii) of the preceding sentence shall be treated as such an order. (C) Alternate recipient The term ‘‘alternate recipient’’ means any child of a participant who is recognized under a medical child support order as hav- ing a right to enrollment under a group health plan with respect to such participant. Page 567 TITLE 29—LABOR § 1169 (D) Child The term ‘‘child’’ includes any child adopt- ed by, or placed for adoption with, a partici- pant of a group health plan. (3) Information to be included in qualified order A medical child support order meets the re- quirements of this paragraph only if such order clearly specifies— (A) the name and the last known mailing address (if any) of the participant and the name and mailing address of each alternate recipient covered by the order, except that, to the extent provided in the order, the name and mailing address of an official of a State or a political subdivision thereof may be substituted for the mailing address of any such alternate recipient, (B) a reasonable description of the type of coverage to be provided to each such alter- nate recipient, or the manner in which such type of coverage is to be determined, and (C) the period to which such order applies. (4) Restriction on new types or forms of bene- fits A medical child support order meets the re- quirements of this paragraph only if such order does not require a plan to provide any type or form of benefit, or any option, not oth- erwise provided under the plan, except to the extent necessary to meet the requirements of a law relating to medical child support de- scribed in section 1908 of the Social Security Act [42 U.S.C. 1396g–1] (as added by section 13822 1 of the Omnibus Budget Reconciliation Act of 1993). (5) Procedural requirements (A) Timely notifications and determinations In the case of any medical child support order received by a group health plan— (i) the plan administrator shall promptly notify the participant and each alternate recipient of the receipt of such order and the plan’s procedures for determining whether medical child support orders are qualified medical child support orders, and (ii) within a reasonable period after re- ceipt of such order, the plan administrator shall determine whether such order is a qualified medical child support order and notify the participant and each alternate recipient of such determination. (B) Establishment of procedures for deter- mining qualified status of orders Each group health plan shall establish rea- sonable procedures to determine whether medical child support orders are qualified medical child support orders and to admin- ister the provision of benefits under such qualified orders. Such procedures— (i) shall be in writing, (ii) shall provide for the notification of each person specified in a medical child support order as eligible to receive bene- fits under the plan (at the address included in the medical child support order) of such procedures promptly upon receipt by the plan of the medical child support order, and (iii) shall permit an alternate recipient to designate a representative for receipt of copies of notices that are sent to the alter- nate recipient with respect to a medical child support order. (C) National Medical Support Notice deemed to be a qualified medical child support order (i) In general If the plan administrator of a group health plan which is maintained by the employer of a noncustodial parent of a child or to which such an employer con- tributes receives an appropriately com- pleted National Medical Support Notice promulgated pursuant to section 401(b) of the Child Support Performance and Incen- tive Act of 1998 in the case of such child, and the Notice meets the requirements of paragraphs (3) and (4), the Notice shall be deemed to be a qualified medical child sup- port order in the case of such child. (ii) Enrollment of child in plan In any case in which an appropriately completed National Medical Support No- tice is issued in the case of a child of a par- ticipant under a group health plan who is a noncustodial parent of the child, and the Notice is deemed under clause (i) to be a qualified medical child support order, the plan administrator, within 40 business days after the date of the Notice, shall— (I) notify the State agency issuing the Notice with respect to such child wheth- er coverage of the child is available under the terms of the plan and, if so, whether such child is covered under the plan and either the effective date of the coverage or, if necessary, any steps to be taken by the custodial parent (or by the official of a State or political subdivision thereof substituted for the name of such child pursuant to paragraph (3)(A)) to ef- fectuate the coverage; and (II) provide to the custodial parent (or such substituted official) a description of the coverage available and any forms or documents necessary to effectuate such coverage. (iii) Rule of construction Nothing in this subparagraph shall be construed as requiring a group health plan, upon receipt of a National Medical Sup- port Notice, to provide benefits under the plan (or eligibility for such benefits) in ad- dition to benefits (or eligibility for bene- fits) provided under the terms of the plan as of immediately before receipt of such Notice. (6) Actions taken by fiduciaries If a plan fiduciary acts in accordance with part 4 of this subtitle in treating a medical child support order as being (or not being) a qualified medical child support order, then the plan’s obligation to the participant and each alternate recipient shall be discharged to the extent of any payment made pursuant to such act of the fiduciary. Page 568 TITLE 29—LABOR § 1169 2 So in original. Probably should be section ‘‘13631’’. (7) Treatment of alternate recipients (A) Treatment as beneficiary generally A person who is an alternate recipient under a qualified medical child support order shall be considered a beneficiary under the plan for purposes of any provision of this chapter. (B) Treatment as participant for purposes of reporting and disclosure requirements A person who is an alternate recipient under any medical child support order shall be considered a participant under the plan for purposes of the reporting and disclosure requirements of part 1 of this subtitle. (8) Direct provision of benefits provided to al- ternate recipients Any payment for benefits made by a group health plan pursuant to a medical child sup- port order in reimbursement for expenses paid by an alternate recipient or an alternate re- cipient’s custodial parent or legal guardian shall be made to the alternate recipient or the alternate recipient’s custodial parent or legal guardian. (9) Payment to State official treated as satisfac- tion of plan’s obligation to make payment to alternate recipient Payment of benefits by a group health plan to an official of a State or a political subdivi- sion thereof whose name and address have been substituted for the address of an alter- nate recipient in a qualified medical child sup- port order, pursuant to paragraph (3)(A), shall be treated, for purposes of this subchapter, as payment of benefits to the alternate recipient. (b) Rights of States with respect to group health plans where participants or beneficiaries thereunder are eligible for medicaid benefits (1) Compliance by plans with assignment of rights A group health plan shall provide that pay- ment for benefits with respect to a participant under the plan will be made in accordance with any assignment of rights made by or on behalf of such participant or a beneficiary of the participant as required by a State plan for medical assistance approved under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] pursuant to section 1912(a)(1)(A) of such Act [42 U.S.C. 1396k(a)(1)(A)] (as in effect on Au- gust 10, 1993). (2) Enrollment and provision of benefits with- out regard to medicaid eligibility A group health plan shall provide that, in enrolling an individual as a participant or ben- eficiary or in determining or making any pay- ments for benefits of an individual as a partic- ipant or beneficiary, the fact that the indi- vidual is eligible for or is provided medical as- sistance under a State plan for medical assist- ance approved under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] will not be taken into account. (3) Acquisition by States of rights of third par- ties A group health plan shall provide that, to the extent that payment has been made under a State plan for medical assistance approved under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] in any case in which a group health plan has a legal liability to make payment for items or services constituting such assistance, payment for benefits under the plan will be made in accordance with any State law which provides that the State has acquired the rights with respect to a partici- pant to such payment for such items or serv- ices. (c) Group health plan coverage of dependent children in cases of adoption (1) Coverage effective upon placement for adoption In any case in which a group health plan provides coverage for dependent children of participants or beneficiaries, such plan shall provide benefits to dependent children placed with participants or beneficiaries for adoption under the same terms and conditions as apply in the case of dependent children who are nat- ural children of participants or beneficiaries under the plan, irrespective of whether the adoption has become final. (2) Restrictions based on preexisting condi- tions at time of placement for adoption prohibited A group health plan may not restrict cov- erage under the plan of any dependent child adopted by a participant or beneficiary, or placed with a participant or beneficiary for adoption, solely on the basis of a preexisting condition of such child at the time that such child would otherwise become eligible for cov- erage under the plan, if the adoption or place- ment for adoption occurs while the participant or beneficiary is eligible for coverage under the plan. (3) Definitions For purposes of this subsection— (A) Child The term ‘‘child’’ means, in connection with any adoption, or placement for adop- tion, of the child, an individual who has not attained age 18 as of the date of such adop- tion or placement for adoption. (B) Placement for adoption The term ‘‘placement’’, or being ‘‘placed’’, for adoption, in connection with any place- ment for adoption of a child with any per- son, means the assumption and retention by such person of a legal obligation for total or partial support of such child in anticipation of adoption of such child. The child’s place- ment with such person terminates upon the termination of such legal obligation. (d) Continued coverage of costs of a pediatric vaccine under group health plans A group health plan may not reduce its cov- erage of the costs of pediatric vaccines (as de- fined under section 1928(h)(6) of the Social Secu- rity Act [42 U.S.C. 1396s(h)(6)] as amended by section 13830 2 of the Omnibus Budget Reconcili- Page 569 TITLE 29—LABOR § 1169 ation Act of 1993) below the coverage it provided as of May 1, 1993. (e) Regulations Any regulations prescribed under this section shall be prescribed by the Secretary of Labor, in consultation with the Secretary of Health and Human Services. (Pub. L. 93–406, title I, § 609, as added Pub. L. 103–66, title IV, § 4301(a), Aug. 10, 1993, 107 Stat. 371; amended Pub. L. 104–193, title III, § 381(a), Aug. 22, 1996, 110 Stat. 2257; Pub. L. 105–33, title V, §§ 5611(a), (b), 5612(a), 5613(a), (b), Aug. 5, 1997, 111 Stat. 647, 648; Pub. L. 105–200, title IV, § 401(d), (h)(2)(A)(iii), (B), (3)(A), July 16, 1998, 112 Stat. 662, 668.) Editorial Notes REFERENCES IN TEXT Section 401(b) of the Child Support Performance and Incentive Act of 1998, referred to in subsec. (a)(5)(C)(i), is section 401(b) of Pub. L. 105–200, which was formerly set out as a note under section 651 of Title 42, The Pub- lic Health and Welfare. This chapter, referred to in subsec. (a)(7)(A), was in the original ‘‘this Act’’, meaning Pub. L. 93–406, known as the Employee Retirement Income Security Act of 1974. Titles I, III, and IV of such Act are classified prin- cipally to this chapter. For complete classification of this Act to the Code, see Short Title note set out under section 1001 of this title and Tables. The Social Security Act, referred to in subsec. (b), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Title XIX of the Act is classified generally to subchapter XIX (§ 1396 et seq.) of chapter 7 of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables. AMENDMENTS 1998—Subsec. (a)(2)(B)(ii). Pub. L. 105–200, § 401(h)(2)(A)(iii), substituted ‘‘is made pursuant to’’ for ‘‘enforces’’. Subsec. (a)(2)(D). Pub. L. 105–200, § 401(h)(2)(B), added subpar. (D). Subsec. (a)(5)(C). Pub. L. 105–200, § 401(d), added sub- par. (C). Subsec. (a)(9). Pub. L. 105–200, § 401(h)(3)(A), sub- stituted ‘‘the address of an alternate recipient’’ for ‘‘the name and address of an alternate recipient’’. 1997—Subsec. (a)(1). Pub. L. 105–33, § 5613(b), inserted at end ‘‘A qualified medical child support order with re- spect to any participant or beneficiary shall be deemed to apply to each group health plan which has received such order, from which the participant or beneficiary is eligible to receive benefits, and with respect to which the requirements of paragraph (4) are met.’’ Subsec. (a)(2)(B). Pub. L. 105–33, § 5612(a), inserted at end of concluding provisions ‘‘For purposes of this sub- paragraph, an administrative notice which is issued pursuant to an administrative process referred to in subclause (II) of the preceding sentence and which has the effect of an order described in clause (i) or (ii) of the preceding sentence shall be treated as such an order.’’ Subsec. (a)(3)(A). Pub. L. 105–33, § 5611(a), inserted at end ‘‘except that, to the extent provided in the order, the name and mailing address of an official of a State or a political subdivision thereof may be substituted for the mailing address of any such alternate recipi- ent,’’. Subsec. (a)(3)(B). Pub. L. 105–33, § 5613(a)(1), (2), struck out ‘‘by the plan’’ after ‘‘to be provided’’ and inserted ‘‘and’’ at end. Subsec. (a)(3)(C). Pub. L. 105–33, § 5613(a)(3), sub- stituted a period for ‘‘, and’’ at end. Subsec. (a)(3)(D). Pub. L. 105–33, § 5613(a)(4), struck out subpar. (D) which read as follows: ‘‘each plan to which such order applies.’’ Subsec. (a)(9). Pub. L. 105–33, § 5611(b), added par. (9). 1996—Subsec. (a)(2)(B). Pub. L. 104–193 substituted ‘‘which—’’ for ‘‘issued by a court of competent jurisdic- tion which—’’ in introductory provisions, substituted a comma for a period at end of cl. (ii), and inserted con- cluding provisions after cl. (ii). Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1998 AMENDMENT Amendment by section 401(h)(2)(A)(iii) of Pub. L. 105–200 effective as if included in the enactment of sec- tion 4301(c)(4)(A) of the Omnibus Budget Reconciliation Act of 1993, Pub. L. 103–66, see section 401(h)(2)(C) of Pub. L. 105–200, set out as a note under section 1144 of this title. Pub. L. 105–200, title IV, § 401(h)(3)(B), July 16, 1998, 112 Stat. 668, provided that: ‘‘The amendment made by subparagraph (A) [amending this section] shall be effec- tive as if included in the enactment of section 5611(b) of the Balanced Budget Act of 1997 [Pub. L. 105–33].’’ EFFECTIVE DATE OF 1997 AMENDMENT Pub. L. 105–33, title V, § 5611(c), Aug. 5, 1997, 111 Stat. 647, provided that: ‘‘The amendments made by this sec- tion [amending this section] shall apply with respect to medical child support orders issued on or after the date of the enactment of this Act [Aug. 5, 1997].’’ Pub. L. 105–33, title V, § 5612(b), Aug. 5, 1997, 111 Stat. 647, provided that: ‘‘The amendment made by this sec- tion [amending this section] shall be effective as if in- cluded in the enactment of section 381 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Public Law 104–193; 110 Stat. 2257).’’ Pub. L. 105–33, title V, § 5613(c), Aug. 5, 1997, 111 Stat. 648, provided that: ‘‘The amendments made by this sec- tion [amending this section] shall apply with respect to medical child support orders issued on or after the date of the enactment of this Act [Aug. 5, 1997].’’ EFFECTIVE DATE OF 1996 AMENDMENT Pub. L. 104–193, title III, § 381(b), Aug. 22, 1996, 110 Stat. 2257, provided that: ‘‘(1) IN GENERAL.—The amendments made by this sec- tion [amending this section] shall take effect on the date of the enactment of this Act [Aug. 22, 1996]. ‘‘(2) PLAN AMENDMENTS NOT REQUIRED UNTIL JANUARY 1, 1997.—Any amendment to a plan required to be made by an amendment made by this section shall not be re- quired to be made before the 1st plan year beginning on or after January 1, 1997, if— ‘‘(A) during the period after the date before the date of the enactment of this Act and before such 1st plan year, the plan is operated in accordance with the requirements of the amendments made by this sec- tion; and ‘‘(B) such plan amendment applies retroactively to the period after the date before the date of the enact- ment of this Act and before such 1st plan year. A plan shall not be treated as failing to be operated in accordance with the provisions of the plan merely be- cause it operates in accordance with this paragraph.’’ [For provisions relating to effective date of title III of Pub. L. 104–193, see section 395(a)–(c) of Pub. L. 104–193, set out as a note under section 654 of Title 42, The Public Health and Welfare.] NATIONAL MEDICAL SUPPORT NOTICES FOR HEALTH PLANS; QUALIFIED MEDICAL CHILD SUPPORT ORDERS Pub. L. 105–200, title IV, § 401(e)–(g), July 16, 1998, 112 Stat. 663–668, as amended by Pub. L. 109–171, title VII, § 7307(a)(2)(B), (C), Feb. 8, 2006, 120 Stat. 146, provided that: ‘‘(e) NATIONAL MEDICAL SUPPORT NOTICES FOR STATE OR LOCAL GOVERNMENTAL GROUP HEALTH PLANS.— ‘‘(1) IN GENERAL.—Each State or local governmental group health plan shall provide benefits in accord- ance with the applicable requirements of any Na- tional Medical Support Notice. Page 570 TITLE 29—LABOR § 1169 ‘‘(2) ENROLLMENT OF CHILD IN PLAN.—In any case in which an appropriately completed National Medical Support Notice is issued in the case of a child of a participant under a State or local governmental group health plan, the plan administrator, within 40 business days after the date of the Notice, shall— ‘‘(A) notify the State agency issuing the Notice with respect to such child whether coverage of the child is available under the terms of the plan and, if so, whether such child is covered under the plan and either the effective date of the coverage or any steps necessary to be taken by the custodial parent (or by any official of a State or political subdivi- sion thereof substituted in the Notice for the name of such child in accordance with procedures appliable [sic] under subsection (b)(2) of this section [section 401(b)(2) of Pub. L. 105–200, 42 U.S.C. 651 note]) to effectuate the coverage; and ‘‘(B) provide to the custodial parent (or such sub- stituted official) a description of the coverage available and any forms or documents necessary to effectuate such coverage. ‘‘(3) RULE OF CONSTRUCTION.—Nothing in this sub- section shall be construed as requiring a State or local governmental group health plan, upon receipt of a National Medical Support Notice, to provide bene- fits under the plan (or eligibility for such benefits) in addition to benefits (or eligibility for benefits) pro- vided under the terms of the plan as of immediately before receipt of such Notice. ‘‘(4) DEFINITIONS.—For purposes of this subsection— ‘‘(A) STATE OR LOCAL GOVERNMENTAL GROUP HEALTH PLAN.—The term ‘State or local govern- mental group health plan’ means a group health plan which is established or maintained for its em- ployees by the government of any State, any polit- ical subdivision of a State, or any agency or instru- mentality of either of the foregoing. ‘‘(B) ALTERNATE RECIPIENT.—The term ‘alternate recipient’ means any child of a participant who is recognized under a National Medical Support No- tice as having a right to enrollment under a State or local governmental group health plan with re- spect to such participant. ‘‘(C) GROUP HEALTH PLAN.—The term ‘group health plan’ has the meaning provided in section 607(1) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1167(1)]. ‘‘(D) STATE.—The term ‘State’ includes the Dis- trict of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, and American Samoa. ‘‘(E) OTHER TERMS.—The terms ‘participant’ and ‘administrator’ shall have the meanings provided such terms, respectively, by paragraphs (7) and (16) of section 3 of the Employee Retirement Income Se- curity Act of 1974 [29 U.S.C. 1002]. ‘‘(5) EFFECTIVE DATE.—The provisions of this sub- section shall take effect on the date of the issuance of interim regulations pursuant to subsection (b)(4) of this section [section 401(b)(4) of Pub. L. 105–200, 42 U.S.C. 651 note]. ‘‘(f) QUALIFIED MEDICAL CHILD SUPPORT ORDERS AND NATIONAL MEDICAL SUPPORT NOTICES FOR CHURCH PLANS.— ‘‘(1) IN GENERAL.—Each church group health plan shall provide benefits in accordance with the applica- ble requirements of any qualified medical child sup- port order. A qualified medical child support order with respect to any participant or beneficiary shall be deemed to apply to each such group health plan which has received such order, from which the partic- ipant or beneficiary is eligible to receive benefits, and with respect to which the requirements of para- graph (4) are met. ‘‘(2) DEFINITIONS.—For purposes of this subsection— ‘‘(A) CHURCH GROUP HEALTH PLAN.—The term ‘church group health plan’ means a group health plan which is a church plan. ‘‘(B) QUALIFIED MEDICAL CHILD SUPPORT ORDER.— The term ‘qualified medical child support order’ means a medical child support order— ‘‘(i) which creates or recognizes the existence of an alternate recipient’s right to, or assigns to an alternate recipient the right to, receive benefits for which a participant or beneficiary is eligible under a church group health plan; and ‘‘(ii) with respect to which the requirements of paragraphs (3) and (4) are met. ‘‘(C) MEDICAL CHILD SUPPORT ORDER.—The term ‘medical child support order’ means any judgment, decree, or order (including approval of a settlement agreement) which— ‘‘(i) provides for child support with respect to a child of a participant under a church group health plan or provides for health benefit coverage to such a child, is made pursuant to a State domes- tic relations law (including a community prop- erty law), and relates to benefits under such plan; or ‘‘(ii) is made pursuant to a law relating to med- ical child support described in section 1908 of the Social Security Act [42 U.S.C. 1396g–1] (as added by section 13822 [13623] of the Omnibus Budget Reconciliation Act of 1993 [Pub. L. 103–66]) with respect to a church group health plan, if such judgment, decree, or order: (I) is issued by a court of competent jurisdiction; or (II) is issued through an administrative process established under State law and has the force and effect of law under applicable State law. For purposes of this paragraph, an administrative notice which is issued pursuant to an administrative process referred to in subclause (II) of the preceding sentence and which has the effect of an order described in clause (i) or (ii) of the preceding sentence shall be treated as such an order. ‘‘(D) ALTERNATE RECIPIENT.—The term ‘alternate recipient’ means any child of a participant who is recognized under a medical child support order as having a right to enrollment under a church group health plan with respect to such participant. ‘‘(E) GROUP HEALTH PLAN.—The term ‘group health plan’ has the meaning provided in section 607(1) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1167(1)]. ‘‘(F) STATE.—The term ‘State’ includes the Dis- trict of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, and American Samoa. ‘‘(G) OTHER TERMS.—The terms ‘participant’, ‘ben- eficiary’, ‘administrator’, and ‘church plan’ shall have the meanings provided such terms, respec- tively, by paragraphs (7), (8), (16), and (33) of section 3 of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1102]. ‘‘(3) INFORMATION TO BE INCLUDED IN QUALIFIED ORDER.—A medical child support order meets the re- quirements of this paragraph only if such order clear- ly specifies— ‘‘(A) the name and the last known mailing ad- dress (if any) of the participant and the name and mailing address of each alternate recipient covered by the order, except that, to the extent provided in the order, the name and mailing address of an offi- cial of a State or a political subdivision thereof may be substituted for the mailing address of any such alternate recipient; ‘‘(B) a reasonable description of the type of cov- erage to be provided to each such alternate recipi- ent, or the manner in which such type of coverage is to be determined; and ‘‘(C) the period to which such order applies. ‘‘(4) RESTRICTION ON NEW TYPES OR FORMS OF BENE- FITS.—A medical child support order meets the re- quirements of this paragraph only if such order does not require a church group health plan to provide any type or form of benefit, or any option, not otherwise provided under the plan, except to the extent nec- essary to meet the requirements of a law relating to medical child support described in section 1908 of the Social Security Act [42 U.S.C. 1396g–1] (as added by Page 571 TITLE 29—LABOR § 1181 section 13822 [13623] of the Omnibus Budget Reconcili- ation Act of 1993 [Pub. L. 103–66]). ‘‘(5) PROCEDURAL REQUIREMENTS.— ‘‘(A) TIMELY NOTIFICATIONS AND DETERMINA- TIONS.—In the case of any medical child support order received by a church group health plan— ‘‘(i) the plan administrator shall promptly no- tify the participant and each alternate recipient of the receipt of such order and the plan’s proce- dures for determining whether medical child sup- port orders are qualified medical child support or- ders; and ‘‘(ii) within a reasonable period after receipt of such order, the plan administrator shall deter- mine whether such order is a qualified medical child support order and notify the participant and each alternate recipient of such determination. ‘‘(B) ESTABLISHMENT OF PROCEDURES FOR DETER- MINING QUALIFIED STATUS OF ORDERS.—Each church group health plan shall establish reasonable proce- dures to determine whether medical child support orders are qualified medical child support orders and to administer the provision of benefits under such qualified orders. Such procedures— ‘‘(i) shall be in writing; ‘‘(ii) shall provide for the notification of each person specified in a medical child support order as eligible to receive benefits under the plan (at the address included in the medical child support order) of such procedures promptly upon receipt by the plan of the medical child support order; and ‘‘(iii) shall permit an alternate recipient to des- ignate a representative for receipt of copies of no- tices that are sent to the alternate recipient with respect to a medical child support order. ‘‘(C) NATIONAL MEDICAL SUPPORT NOTICE DEEMED TO BE A QUALIFIED MEDICAL CHILD SUPPORT ORDER.— ‘‘(i) IN GENERAL.—If the plan administrator of any church group health plan which is main- tained by the employer of a parent of a child or to which such an employer contributes receives an appropriately completed National Medical Support Notice promulgated pursuant to sub- section (b) of this section [section 401(b) of Pub. L. 105–200, 42 U.S.C. 651 note] in the case of such child, and the Notice meets the requirements of paragraphs (3) and (4) of this subsection, the No- tice shall be deemed to be a qualified medical child support order in the case of such child. ‘‘(ii) ENROLLMENT OF CHILD IN PLAN.—In any case in which an appropriately completed Na- tional Medical Support Notice is issued in the case of a child of a participant under a church group health plan who is a parent of the child, and the Notice is deemed under clause (i) to be a qualified medical child support order, the plan ad- ministrator, within 40 business days after the date of the Notice, shall— ‘‘(I) notify the State agency issuing the No- tice with respect to such child whether cov- erage of the child is available under the terms of the plan and, if so, whether such child is cov- ered under the plan and either the effective date of the coverage or any steps necessary to be taken by the custodial parent (or by the official of a State or political subdivision thereof sub- stituted for the name of such child pursuant to paragraph (3)(A)) to effectuate the coverage; and ‘‘(II) provide to the custodial parent (or such substituted official) a description of the cov- erage available and any forms or documents necessary to effectuate such coverage. ‘‘(iii) RULE OF CONSTRUCTION.—Nothing in this subparagraph shall be construed as requiring a church group health plan, upon receipt of a Na- tional Medical Support Notice, to provide bene- fits under the plan (or eligibility for such bene- fits) in addition to benefits (or eligibility for ben- efits) provided under the terms of the plan as of immediately before receipt of such Notice. ‘‘(6) DIRECT PROVISION OF BENEFITS PROVIDED TO AL- TERNATE RECIPIENTS.—Any payment for benefits made by a church group health plan pursuant to a medical child support order in reimbursement for expenses paid by an alternate recipient or an alternate recipi- ent’s custodial parent or legal guardian shall be made to the alternate recipient or the alternate recipient’s custodial parent or legal guardian. ‘‘(7) PAYMENT TO STATE OFFICIAL TREATED AS SATIS- FACTION OF PLAN’S OBLIGATION TO MAKE PAYMENT TO ALTERNATE RECIPIENT.—Payment of benefits by a church group health plan to an official of a State or a political subdivision thereof whose name and ad- dress have been substituted for the address of an al- ternate recipient in a medical child support order, pursuant to paragraph (3)(A), shall be treated, for purposes of this subsection and part D of title IV of the Social Security Act [42 U.S.C. 651 et seq.], as pay- ment of benefits to the alternate recipient. ‘‘(8) EFFECTIVE DATE.—The provisions of this sub- section shall take effect on the date of the issuance of interim regulations pursuant to subsection (b)(4) of this section [section 401(b)(4) of Pub. L. 105–200, 42 U.S.C. 651 note]. ‘‘(g) REPORT AND RECOMMENDATIONS REGARDING THE ENFORCEMENT OF QUALIFIED MEDICAL CHILD SUPPORT ORDERS.—Not later than 8 months after the issuance of the report to the Congress pursuant to subsection (a)(5) [section 401(a)(5) of Pub. L. 105–200, 42 U.S.C. 651 note], the Secretary of Health and Human Services and the Secretary of Labor shall jointly submit to each House of the Congress a report containing recommendations for appropriate legislation to improve the effectiveness of, and enforcement of, qualified medical child support orders under the provisions of subsection (f) of this sec- tion and section 609(a) of the Employee Retirement In- come Security Act of 1974 (29 U.S.C. 1169(a)).’’ PLAN AMENDMENTS NOT REQUIRED UNTIL JANUARY 1, 1994 For provisions setting forth circumstances under which any amendment to a plan required to be made by an amendment made by section 4301(d) of Pub. L. 103–66 shall not be required to be made before the first plan year beginning on or after Jan. 1, 1994, see section 4301(d) of Pub. L. 103–66, set out as an Effective Date of 1993 Amendment note under section 1021 of this title. PART 7—GROUP HEALTH PLAN REQUIREMENTS Subpart A—Requirements Relating to Portability, Access, and Renewability § 1181. Increased portability through limitation on preexisting condition exclusions (a) Limitation on preexisting condition exclusion period; crediting for periods of previous cov- erage Subject to subsection (d), a group health plan, and a health insurance issuer offering group health insurance coverage, may, with respect to a participant or beneficiary, impose a pre- existing condition exclusion only if— (1) such exclusion relates to a condition (whether physical or mental), regardless of the cause of the condition, for which medical ad- vice, diagnosis, care, or treatment was rec- ommended or received within the 6-month pe- riod ending on the enrollment date; (2) such exclusion extends for a period of not more than 12 months (or 18 months in the case of a late enrollee) after the enrollment date; and (3) the period of any such preexisting condi- tion exclusion is reduced by the aggregate of