Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 21 - TRADE PRACTICES
Subchapter L - MEDICAL CHILD SUPPORT, UNFAIR PRACTICES
Section 21.2004 - Enrollment of Child Who Is the Subject of a Medical Support Order

Universal Citation: 28 TX Admin Code § 21.2004

Current through Reg. 50, No. 13; March 28, 2025

(a) If the insurer offers coverage of dependent children under the policy, enrollment of a child who is the subject of a medical support order in the health coverage shall be automatic for the first 31 days after receipt of a medical support order or notice of a medical support order by the employer, or the insurer if there is no employer and the insurer provides health coverage to the parent ordered to provide medical support. The insurer shall enroll the child without regard to any enrollment period restriction that might otherwise be applicable to the parent or the child. Receipt of a medical support order or notice of a medical support order requiring that health coverage be provided for a child shall be considered a change in the family circumstances of the employee or member, for health coverage purposes, equivalent to the birth or adoption of a child. For purposes of this section, the change of family circumstances shall not be construed to require coverage of any person other than the child subject to the court order and, if not already covered, the parent ordered to provide medical support.

(b) Within 31 days after receipt of a medical support order or notice of a medical support order by the employer or the insurer as specified in subsection (a) of this section, the insurer shall complete all necessary forms and procedures to enroll the child in health coverage on a permanent basis:

(1) on application of a parent of the child, a custodial parent of the child, a child support agency having a duty to collect or enforce support for the child, or the child over 18 years of age; and

(2) if the required premium is paid within 31 days of the receipt of the medical support order or notice of the medical support order by the employer, or the insurer if there is no employer except that the insurer shall not terminate coverage of a child that is the subject of a medical support order if such insurer's billing cycle does not coincide with this 31 day premium payment requirement, until the next billing cycle has occurred and there has been nonpayment of the additional required premium, within 30 days of the due date of such premium.

(c) As a prerequisite to the child's permanent enrollment in group health coverage, an insurer offering coverage of dependent children may require the parent, who is required by a medical support order to provide coverage, and who is eligible for dependent health coverage, if not already enrolled, to enroll in the health coverage plan within 31 days after receipt of a medical support order or notice of a medical support order by the employer, or the insurer if there is no employer.

(d) If the child is not enrolled on a permanent basis, the insurer shall report in accordance with the Family Code, Chapter 154, Subchapter D, the reasons coverage cannot be made permanent.

(e) With respect to a child residing outside the insurer's service area, the insurer shall not use the child's status as the subject of a medical support order to charge a higher premium for coverage of the child than it charges for coverage of other dependent children under the policy.

(f) The application of subsection (e) of this section is illustrated in the following paragraphs and assumes a monthly premium for Employee Only coverage is $210; a monthly premium for Employee and Child(ren) coverage is $430; and a monthly premium for Family coverage is $650.

(1) An employee who elected Employee Only coverage must subsequently provide coverage to 2 children pursuant to a medical support order. The total premium charged to this employee for adding the 2 children may not exceed $220 ($430 minus $210).

(2) An employee who elected Employee and Child(ren) coverage must subsequently provide coverage to an additional child pursuant to a medical support order. The employee may not be charged an additional premium for adding the additional child.

(3) An employee who elected Family coverage must subsequently provide coverage to an additional child pursuant to a medical support order. The employee may not be charged an additional premium for adding the additional child.

Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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