Page 61 - HarborLight CU 2014-15 SPD
P. 61
Letter Acknowledging Receipt of Order
(QMCSO Procedures Attachment #3)
[Date]
[Participant]
[Address]
[Alternate Recipient Child or Designate Named in QMCSO] [Address]
Dear [Participant] and [Alternate Recipient Child or Designate]:
This is to advise you that on [Date], we received a child support order relating to the
coverage of [Alternate Recipient/s] under the [Plan] as [a child ] [children] of [Participant].
We are in the process of reviewing this order to determine if it is a "Qualified Medical Child
Support Order" (QMCSO), as defined in section 609(a) of the Employee Retirement Income
Security Act of 1974 (ERISA). Our review process will include an inquiry as to [Participant]'s
eligibility for medical benefits under the Plan, as well as a review of the terms of the order to
determine if it complies with the provisions of the Plan and applicable federal law.
We will notify you in writing of our preliminary determination, and if we find that this order is
not a QMCSO, we will advise you as to what corrective steps are necessary. Within 30
days from the date you receive that notice, you (or your attorney) will have the right to
submit written comments regarding our determination. After considering any comments
received, we will make a final determination as to the qualified status of the order. If no
comments are received during that 30-day period, the decision will become final.
Please keep us advised as to your current mailing address while these procedures are
pending. In addition, please advise us if there is any individual who should be receiving
copies of correspondence relating to any benefits that may be available to [Alternate
Recipient/s]. Your cooperation is appreciated.
Sincerely,
[Name]
cc: [Participant's Attorney, if any]
[Alternate Recipient's Attorney, if any]
56
(QMCSO Procedures Attachment #3)
[Date]
[Participant]
[Address]
[Alternate Recipient Child or Designate Named in QMCSO] [Address]
Dear [Participant] and [Alternate Recipient Child or Designate]:
This is to advise you that on [Date], we received a child support order relating to the
coverage of [Alternate Recipient/s] under the [Plan] as [a child ] [children] of [Participant].
We are in the process of reviewing this order to determine if it is a "Qualified Medical Child
Support Order" (QMCSO), as defined in section 609(a) of the Employee Retirement Income
Security Act of 1974 (ERISA). Our review process will include an inquiry as to [Participant]'s
eligibility for medical benefits under the Plan, as well as a review of the terms of the order to
determine if it complies with the provisions of the Plan and applicable federal law.
We will notify you in writing of our preliminary determination, and if we find that this order is
not a QMCSO, we will advise you as to what corrective steps are necessary. Within 30
days from the date you receive that notice, you (or your attorney) will have the right to
submit written comments regarding our determination. After considering any comments
received, we will make a final determination as to the qualified status of the order. If no
comments are received during that 30-day period, the decision will become final.
Please keep us advised as to your current mailing address while these procedures are
pending. In addition, please advise us if there is any individual who should be receiving
copies of correspondence relating to any benefits that may be available to [Alternate
Recipient/s]. Your cooperation is appreciated.
Sincerely,
[Name]
cc: [Participant's Attorney, if any]
[Alternate Recipient's Attorney, if any]
56
