Virginia Code 38.2-3407.2: Coverage for medical child support.
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.
Terms Used In Virginia Code 38.2-3407.2
- Contract: A legal written agreement that becomes binding when signed.
- Dependent: A person dependent for support upon another.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Health services plan: means any arrangement for offering or administering health services or similar or related services by a corporation licensed under Virginia Code 38.2-100
- Insurer: means an insurance company. See Virginia Code 38.2-100
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a. Such court or administrative order is no longer in effect;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.
1994, c. 213.