CODE OF VIRGINIA

COVERAGE FOR MEDICAL CHILD SUPPORT (§ 38.2-3407.2)

A. No insurer, health services plan, or health maintenance organization shall
refuse to enroll a child under a parent’s coverage because (i) the child
was born out of wedlock; (ii) the child is not claimed as a dependent on the
parent’s federal income tax return; or (iii) the child does not reside
with the parent or in the insurer’s, health services plan’s, or
health maintenance organization’s service area.

B. Upon receipt of proof that a parent eligible for family coverage under an
accident and sickness policy, health services plan, or health maintenance
organization contract has been required by a court or administrative order to
provide health coverage for a child, the insurer, health services plan, or
health maintenance organization shall:

   1.  Permit such parent to enroll under such family coverage any such child who
   is otherwise eligible for such coverage, without regard to any enrollment
   season restrictions;

   2.  If such parent is enrolled but fails to make application to obtain
   coverage for such child, enroll such child upon application by the
   child’s other parent or by the Department of Social Services; and

   3.  Not disenroll or otherwise eliminate coverage of such child unless the
   insurer, health services plan, or health maintenance organization is provided
   satisfactory written evidence that:
               
               
            

      a.  Such court or administrative order is no longer in effect;

      b.  Such child is or will be enrolled in comparable health coverage through
      another insurer, health services plan, or health maintenance organization
      which will take effect not later than the effective date of termination of
      the child’s coverage under the policy or contract issued by the
      insurer, health services plan, or health maintenance organization; or

      c.  Family health coverage has been eliminated under the insurance policy,
      health services plan, or health maintenance organization contract.

C. Any insurer, health services plan, or health maintenance organization
providing coverage to the child of a noncustodial parent shall (i) provide to
the custodial parent, upon request, any information that is necessary to obtain
benefits for such child under such coverage; (ii) permit the custodial parent,
or the provider of health services if approved by the custodial parent, to
submit claims for services without the approval of the noncustodial parent; and
(iii) make payment on claims submitted pursuant to clause (ii) directly to such
custodial parent, provider, or the Department of Medical Assistance Services.

HISTORY: 1994, c. 213.