(1) The child was born out of wedlock;
(2) The child is not claimed as a dependent on the parent=s Guam tax return;
(3) The child does not reside with the parent or in the insurer=s service area;

(4) The child has a pre-existing or excluded medical condition; or

(5) The child is adopted or is the subject of adoption proceedings.

COL120106
10 Guam Code Ann. HEALTH AND SAFETY
CH. 95 COORDINATION OF BENEFITS

(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 subparagraph (2) of this section 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 health coverage, the insurer shall be required:

(1) To permit the parent to enroll, under the family coverage, a child who is otherwise eligible for the coverage without regard to any enrollment season or open enrollment 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 upon
application of the child=s other parent, the local agency administering
the Medicaid program or the local agency administering ”651 to 669,
Title 42 United States Code, 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:

(i) The court or administrative order is no longer in effect; or

(ii) The child is or will be enrolled in comparable health coverage through another insurer which will take effect not later than the effective date of disenrollment.
(d) An insurer may not impose requirements on a territorial 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.