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25-533 Insurer obligations

A. If a court or administrative order requires a parent to provide health coverage for a child and the parent is eligible for family coverage, the insurer shall:

1. Permit the parent to enroll the child under the family coverage if the child is otherwise eligible for the coverage without regard to any enrollment season restrictions.

2. If the parent is enrolled in family coverage but fails to enroll the child, enroll the child under the family coverage on the application of the child’s other parent or the state IV-D agency.

3. Not refuse to enroll or terminate the coverage of the child unless the insurer receives satisfactory written evidence that one of the following applies:

(a) The court or administrative order is no longer in effect.

(b) The child will be enrolled in comparable health coverage through another insurer and that coverage will take effect not later than the effective date of the termination of coverage.

(c) The employer has eliminated family health coverage for all of its employees.

(d) Nonpayment of premium.

B. An insurer shall not impose any additional requirements on state agencies or the other parent that are different from the requirements the insurer imposes on all other agents or assignees. An insurer shall provide the state or the other parent with enrollment information and shall process the claims from and make payments to the state, the other parent or the other parent’s provider.

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