The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that governs how employee benefit plans for most private employers must be administered. Although the name of the statute suggests that it applies to pensions, it applies to other employee benefits, including group health plans. In 1993, ERISA was amended by the Omnibus Reconciliation Act to allow children of a group health plan participant to receive health plan benefits under an order from a state court or agency in a domestic relations case even if the child was not ordinarily eligible for such benefits under the terms of the plan. Such an order is called a "medical child support order," and the child who is the subject of the order is referred to as an "alternate recipient" of the health plan benefits.

In order for a plan administrator to be obligated to comply with the order and enroll the child or children in the group health plan, the medical child support order must be "qualified." For the order to be qualified, the administrator must be supplied with the name and last known mailing address, if any, of the plan participant and the name and mailing address of the child or children. If the order allows, the name and mailing address of a state or political subdivision of the state may be substituted for that of the child or children. The plan administrator must also be supplied with a description of the type of coverage that is to be provided to the child or the manner in which the type of coverage will be determined, as well as the period for which the coverage is to apply. A qualified medical child support order may not order a child to receive benefits that are not ordinarily offered by the plan except to the extent that the plan imposes eligibility requirements that are not allowed by the Social Security Act.

Once a medical child support order is determined to be qualified, the child is treated as a beneficiary under the plan for purposes of ERISA. For the purposes of the reporting and disclosure required by ERISA, a child is treated as a plan participant and thus is entitled to receive all of the disclosures and notices concerning the group health plan as are ordinary plan participants.

An ERISA-governed group health plan is required to establish written procedures for determining whether a medical child support order is qualified. When the plan administrator receives a medical child support order, each person specified in the order must receive a copy of the procedures from the plan administrator. The administrator must also allow a child who is the subject of a medical child support order to designate a representative to receive mailings or communications on behalf of the child.

Payments made under a qualified medical child support order to reimburse medical expenses paid by the child or the child's custodial parent or legal guardian are to be paid to the child or the child's custodial parent or legal guardian. If the child's address has been substituted by the name and address of a state official, payment to that state official will satisfy the plan's payment obligation under the qualified medical child support order.

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