Page 62 - HarborLight CU 2014-15 SPD
P. 62
Letter Accepting Valid Order
(QMCSO Procedures Attachment #4)
[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 we have reviewed the court order received on [Date], relating to the
coverage of [Alternate Recipients] under the [Plan] as [a child] [children] of [Participant]. We
have determined this order to be a valid Qualified Medical Child Support Order (QMCSO) as
defined in Section 609(a) of the Employee Retirement Income Security Act (ERISA).
[Include one of the two alternative paragraphs below. The first paragraph is included if the child
is not currently enrolled as a dependent under the Plan. The second paragraph is included if the
child is a current dependent.]
[Alternate 1:
Coverage for [Alternate Recipients] will not begin until after a completed application form has
been filed with the plan administrator, and all other conditions for coverage have been met in
accordance with the rules of the Plan.]
[Note: Because the law is unclear, some plans may wish to be conservative and allow for
enrollment retroactive to the date of the QMCSO.]
[Alternate 2:
Our records indicate that [Alternate Recipient/s] is already an eligible dependent (are already
eligible dependents) of [Participant] under the terms of the Plan, and there will be no interruption
in coverage as a result of the court order.]
Coverage for [Alternate Recipient/s] will. only continue as long as otherwise provided for under
the terms of the Plan. Among other things, this means coverage ends (subject to COBRA)
whether the [Participant] or [Alternate Recipient/s] cease to be eligible.
Please keep us informed of your current address. Also, please advise us as to whether copies
of correspondence relating to [Alternate Recipient's] benefits should be forwarded to any
designated representative.
Sincerely,
[Name]
cc: [Participant's Attorney, if any]
[Alternate Recipient's Attorney, if any]
Letter Rejecting Invalid Order
(QMCSO Procedures Attachment #5)
[Date]
[Participant]
57
(QMCSO Procedures Attachment #4)
[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 we have reviewed the court order received on [Date], relating to the
coverage of [Alternate Recipients] under the [Plan] as [a child] [children] of [Participant]. We
have determined this order to be a valid Qualified Medical Child Support Order (QMCSO) as
defined in Section 609(a) of the Employee Retirement Income Security Act (ERISA).
[Include one of the two alternative paragraphs below. The first paragraph is included if the child
is not currently enrolled as a dependent under the Plan. The second paragraph is included if the
child is a current dependent.]
[Alternate 1:
Coverage for [Alternate Recipients] will not begin until after a completed application form has
been filed with the plan administrator, and all other conditions for coverage have been met in
accordance with the rules of the Plan.]
[Note: Because the law is unclear, some plans may wish to be conservative and allow for
enrollment retroactive to the date of the QMCSO.]
[Alternate 2:
Our records indicate that [Alternate Recipient/s] is already an eligible dependent (are already
eligible dependents) of [Participant] under the terms of the Plan, and there will be no interruption
in coverage as a result of the court order.]
Coverage for [Alternate Recipient/s] will. only continue as long as otherwise provided for under
the terms of the Plan. Among other things, this means coverage ends (subject to COBRA)
whether the [Participant] or [Alternate Recipient/s] cease to be eligible.
Please keep us informed of your current address. Also, please advise us as to whether copies
of correspondence relating to [Alternate Recipient's] benefits should be forwarded to any
designated representative.
Sincerely,
[Name]
cc: [Participant's Attorney, if any]
[Alternate Recipient's Attorney, if any]
Letter Rejecting Invalid Order
(QMCSO Procedures Attachment #5)
[Date]
[Participant]
57
