§ 19-11-27.Accident and sickness insurance coverage for children; National Medical Support Notice or other notice of enrollment; establishment of coverage

This section supplies the enforcement machinery when a parent ordered to carry accident and sickness insurance for a child doesn’t. If a party required by a court order to maintain coverage fails to provide it or lets it lapse, the Department of Human Services, the Department of Community Health or the other party may compel the medical insurance obligor to obtain coverage. These remedies add to any others available.

The main tool is a notice to the obligor’s employer, union or other source of coverage. The child support enforcement agency issues the National Medical Support Notice, a federal form, when appropriate in cases it handles under § 19-11-8, but it need not do so when the order provides for coverage that isn’t employer based. Any of the three enforcers may send a notice of enrollment or National Medical Support Notice by certified mail or statutory overnight delivery, return receipt requested, with a certified copy of the latest order requiring coverage and the sender’s return address. The employer then withholds the premium from the obligor’s income, within the limits of the federal Consumer Credit Protection Act.

In IV-D cases the agency must tell the obligor in writing that the notice went to the employer or union and explain the obligor’s rights and duties. The obligor may contest the withholding based on a mistake of fact by filing a written notice of contest with the agency within 15 business days from the date of the notice. The agency then has five business days to schedule an informal conference. If the conference resolves the dispute to the obligor’s satisfaction, or the obligor doesn’t attend, the contest is deemed withdrawn. If it doesn’t, the obligor may request a hearing before an administrative law judge within five business days after learning the result. None of this delays the withholding, which continues unless the agency, a court or the Office of State Administrative Hearings says the notice is terminated.

Subsection (g) sets a timetable. Within 20 business days after the date of the notice, the employer must either report that the obligor isn’t an employee or has no plan available, or forward the plan administrator’s portion to each plan administrator. The plan administrator enrolls the child, and the parent too if needed, choosing the parent’s current plan if it offers dependent coverage, the only plan with dependent coverage if there’s just one, and otherwise, on a Georgia agency notice, the accessible plan with the lowest employee premium, preferring basic coverage. Within 40 business days after the notice date, the plan administrator must return its response, tell the parents and child about the coverage, and flag any waiting period running more than 90 days. The section was last amended in 2017.