- (a) If a parent eligible for dependent health coverage through an insurer is required by a medical support order to provide health coverage for a child, the insurer shall permit the parent to enroll the child without regard to any enrollment period restriction that might otherwise be applicable to the parent or the child. Receipt of a medical support order requiring that health coverage be provided for a child shall be considered a change in the family circumstances of the employee or member, for health coverage purposes, equivalent to the birth or adoption of a child.
- (b) If a parent eligible for dependent health coverage through an insurer is required by a medical support order to provide health coverage for a child and fails to apply to obtain the health coverage for the child, the insurer shall enroll the child on application of a custodial parent of the child, a child support agency having a duty to collect or enforce support for the child, or the child over 18 years of age without regard to any enrollment period restriction that might otherwise be applicable to the parent or the child.
- (c) Enrollment shall be automatic for the first 31 days after receipt of a medical support order by the employer or the insurer if there is no employer. During the 31-day period, the insurer shall complete all necessary forms and procedures to make the enrollment permanent or shall report in accordance with the Family Code, Chapter 154, Subchapter D, the reasons the coverage cannot be made permanent. To continue coverage beyond 31 days, the required premium shall be paid within 31 days of the employer's receipt of the medical support order. If there is no employer, to continue coverage beyond 31 days, the required premium shall be paid within 31 days of the insurer's receipt of the medical support order. An insurer shall not terminate coverage of a child that is the subject of a medical support order if such insurer's billing cycle does not coincide with this 31-day premium payment requirement, until the next billing cycle has occurred and there has been nonpayment of the additional required premium, within 30 days of the due date of such premium.
Source Note:The provisions of this §21.2004 adopted to be effective May 8, 1997, 22 TexReg 3799.