§431L-3 Coverage of children.

413 words·~2 min read·/hi/431l-3

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)No insurer shall deny enrollment of a child under the health plan of the child's parent for the following grounds:

(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.

(b)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 paragraph

(2)directly to the custodial parent, the provider, or the state medicaid agency.

(c)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 coverage, as defined in section 431:10A-103, and reciprocal beneficiary family coverage, as defined in section 431:10A-601, the insurer shall be required:

(1)To permit the parent to enroll, under the family coverage or reciprocal beneficiary 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, to enroll the child under family coverage or reciprocal beneficiary family coverage upon application of the child's other parent, the state agency administering the medicaid program, or the state agency administering the child support enforcement program; and

(3)Not to 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(A)The court or administrative order is no longer in effect; or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 that will take effect not later than the effective date of disenrollment.

(d)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. [L 1995, c 83, pt of §2; am L 1997, c 383, §8; am L 2004, c 122, §81]