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Library: Policy

340:25-5-171. Enforcement of a medical support order

Revised 7-1-12

(a) When a parent has been ordered to provide health insurance for the child(ren) and has failed to voluntarily enroll the child(ren), Oklahoma Child Support Services (OCSS), uses the National Medical Support Notice (NMSN) to aid in enrolling the child(ren) in the group health plans for which a parent is eligible.  OCSS sends the NMSN to the parent's employer as required by Section 666 of Title 42 of the United States Code, Section 609 of the Employee Retirement Income Security Act of 1974, Section 303.32 of Title 45 of the Code of Federal Regulations, and Section 6058A of Title 36 and Section 118.2 of Title 43 of the Oklahoma Statutes.

(b) In addition to issuing a NMSN, when a parent is ordered to provide medical support for the minor child(ren) and is not complying with the order, OCSS may either:

(c) When a child is eligible for enrollment in the United States Department of Defense's managed health care program, TRICARE, (a) of this Section does not apply.  OCSS notifies the custodial person to contact the Defense Manpower Data Center Support Office at 1-800-538-9552 to enroll the child, using the Defense Enrollment Eligibility Reporting System registration process.  • 1

(d) If the employer response to the NMSN indicates that enrollment cannot be completed because the cost of coverage exceeds the limits of earnings subject to income assignment under Section 1171.2 of Title 12 of the Oklahoma Statutes, OCSS applies OAC 340:25-5-168 to determine if other coverage is available at reasonable cost or if a cash medical order is appropriate.  OCSS conducts a review of the order under OAC 340:25-5-198.1 and seeks a modified order if the review indicates that modification would result in an enforceable medical support order or that the child support order should be adjusted.  • 2

(e) OCSS issues a non-compliance letter to the employer when the employer:

  • (1) has not returned the NMSN within 20 business days after the date of the NMSN notifying OCSS that:

    • (A) the employer does not offer group dependent health coverage;

    • (B) the employee is among a class of employees that is not eligible for family coverage under the employer's plans;

    • (C) the employee is not employed by the employer; or

    • (D) state or federal withholding limitations or prioritization of withholding prevent the required employee contribution to obtain coverage;

  • (2) has not forwarded the NMSN to the insurer within 20 business days after the date of the NMSN; or

  • (3) is the insurer and has not returned the NMSN within 20 business days after the date of the NMSN indicating that either the child(ren) has been enrolled in the plan and the effective date of coverage or there is more than one option available and one must be selected.  • 3

(f) OCSS issues a non-compliance letter to the insurer when the insurer has not returned the NMSN within 40 business days after the date of the NMSN indicating that either the child(ren) has been enrolled in the plan and the effective date of coverage or there is more than one option available and one must be selected.  • 4

(g) OCSS may initiate legal proceedings to request the court fine employers and insurers when there is no response indicating full compliance with the requirements of the NMSN within 10 business days after the date of the non-compliance letter.  Fines may be imposed by the court for up to $200 a month per child for each failure to comply with the requirements of the NMSN under Section 6058A of Title 36 and Section 118.2 of Title 43 of the Oklahoma Statutes.

(h) If the employer or insurer complies with the requirements of the NMSN, OCSS may dismiss the case against the employer or insurer.

(i) Employers and insurers must send any fine(s) imposed by the court, under Section 235 of Title 56 of the Oklahoma Statutes, by check or money order to OCSS, Attention:  Finance, P.O. Box 248822, Oklahoma City, Oklahoma 73124-8822.

(j) When a parent has been ordered to provide health insurance for the child(ren) and the other parent or custodial person has failed or refused to provide information necessary to enroll the child(ren) in the health insurance plan, OCSS:

Revised 7-1-12

1.TRICARE.

(1) Registration for TRICARE is required through the Defense Enrollment Eligibility Reporting System (DEERS).Active-duty and retired servicemembers are automatically registered in DEERS, but additional action is required to enroll eligible dependents.

(2) Federal Case Registry (FCR) data is sent to the Defense Manpower Data Center (DMDC) for matching.DMDC matches the FCR participants with its records and indicates which children are eligible and enrolled for TRICARE.DMDC then sends the health benefits matching information to states.

(3) The Oklahoma Support Information System (OSIS) reports that present data received from the DMDC matches are available through Document Direct of the Report Distribution System and include:

(A) CY909R01, The Child is Currently Enrolled in Medical Coverage;

(B) CY909R02, A Child is Eligible Based on the CP or NCP/PF (Noncustodial Parent/Putative Father) Current Medical Coverage, But is Not Enrolled; and

(C) CY909R03, A Child was Previously Enrolled But Not Currently Enrolled and Neither a CP Nor NCP/PF is Enrolled.

(4) Oklahoma Child Support Services (OCSS) staff:

(A) updates OSIS medical support case information based on the information provided in the OSIS reports; and

(B) sends the custodial person the MEDTRI letter on OSIS to advise of the availability of TRICARE and provide enrollment instructions.

2.Examples of cases in which review of the order would result in an enforceable medical support order include:

(1) a parent can obtain health insurance coverage or alternative health coverage for the child(ren) at no additional cost;

(2) a parent can obtain private health insurance coverage at reasonable cost;

(3) a parent cannot obtain health insurance coverage at a reasonable cost and the court orders cash medical support; and

(4) the child support order can be modified to an amount that considers the premium cost.After modification of the order, the total amount of child support for all orders owed by the noncustodial parent plus the premium cost does not exceed limitations of the Consumer Credit Protection Act.

3.OCSS attempts to contact the employer by telephone to determine compliance if the National Medical Support Notice (NMSN) is not returned within 20 business days after the date of the NMSN.

4.OCSS attempts to contact the insurer by telephone to determine compliance if the NMSN is not returned within 40 business days after the date of the NMSN.

5.When a parent’s failure or refusal to provide information necessary to enroll the child(ren) in the health insurance plan or to access medical services is based on a claim of family violence, child support staff seek a modification of the medical support order to request a cash medical order per OAC 340:25-5-168.

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