CHAPTER 252E
MEDICAL SUPPORT

 
Effective for support orders entered on or after July 1, 1990;

prior orders; §252E.16

Pursuant to federal law, either parent

may be ordered to provide medical support;

2008 Acts, ch 1019, §19

  252E.1  Definitions.
  As used in this chapter, unless the context otherwise requires:
  1.  “Accessible” means any of the following, unless otherwise provided in the support order:
  a.  The health benefit plan does not have service area limitations or provides an option not subject to service area limitations.
  b.  The health benefit plan has service area limitations and the dependent lives within thirty miles or thirty minutes of a network primary care provider.
  2.  “Basic coverage” means coverage provided under a health benefit plan that at a minimum provides coverage for emergency care, inpatient and outpatient hospital care, physician services whether provided within or outside a hospital setting, and laboratory and x-ray services.
  3.  “Child” means a person for whom child or medical support may be ordered pursuant to chapter 234, 239B, 252A, 252C, 252F, 252H, 252K, 598, 600B, or any other chapter of the Code or pursuant to a comparable statute of a foreign jurisdiction.
  4.  “Department” means the department of human services, which includes but is not limited to the child support recovery unit, or any comparable support enforcement agency of another state.
  5.  “Dependent” means a child, or an obligee for whom a court may order coverage by a health benefit plan pursuant to section 252E.3.
  6.  “Enroll” means to be eligible for and covered by a health benefit plan.
  7.  “Health benefit plan” means any policy or contract of insurance, indemnity, subscription or membership issued by an insurer, health service corporation, health maintenance organization, or any similar corporation, organization, or a self-insured employee benefit plan, for the purpose of covering medical expenses. These expenses may include but are not limited to hospital, surgical, major medical insurance, dental, optical, prescription drugs, office visits, or any combination of these or any other comparable health care expenses.
  8.  “Insurer” means any entity which provides a health benefit plan.
  9.  “Medical support” means either the provision of a health benefit plan, including a group or employment-related or an individual health benefit plan, or a health benefit plan provided pursuant to chapter 514E, to meet the medical needs of a dependent and the cost of any premium required by a health benefit plan, or the payment to the obligee of a monetary amount in lieu of a health benefit plan, either of which is an obligation separate from any monetary amount of child support ordered to be paid. Medical support is not alimony. Medical support which consists of payment of a monetary amount in lieu of a health benefit plan is also an obligation separate from any monetary amount a parent is ordered to pay for uncovered medical expenses pursuant to the guidelines established pursuant to section 598.21B.
  10.  “National medical support notice” means a notice as prescribed under 42 U.S.C. §  666(a)(19) or a substantially similar notice, that is issued and forwarded by the department to enforce medical support provisions of a support order.
  11.  “Obligee” means a parent or another natural person legally entitled to receive a support payment on behalf of a child.
  12.  “Obligor” means a parent or another natural person legally responsible for the support of a dependent.
  13.  “Order” means a support order entered pursuant to chapter 234, 252A, 252C, 252F, 252H, 252K, 598, 600B, or any other support chapter, or pursuant to a comparable statute of a foreign jurisdiction, or an ex parte order entered pursuant to section 252E.4. “Order” also includes a notice of such an order issued by the department.
  14.  “Plan administrator” means the employer or sponsor that offers the health benefit plan or the person to whom the duty of plan administrator is delegated by the employer or sponsor offering the health benefit plan, by written agreement of the parties.
  15.  “Primary care provider” means a physician who provides primary care who is a family or general practitioner, a pediatrician, an internist, an obstetrician, or a gynecologist.
90 Acts, ch 1224, §25; 92 Acts, ch 1195, §505; 93 Acts, ch 78, §20; 93 Acts, ch 79, §46; 97 Acts, ch 41, §32; 2000 Acts, ch 1096, §1; 2002 Acts, ch 1018, §3; 2007 Acts, ch 218, §163, 187; 2008 Acts, ch 1019, §18, 20

For transition provisions applicable to existing child support recovery unit rules, procedures, definitions, and requirements, and for nullification of 441 IAC rule 98.3, see 2007 Acts, ch 218, §186 

  252E.1A  Establishing and modifying orders for medical support.
  This section shall apply to all initial or modified orders for support entered under chapter 234, 252A, 252C, 252F, 252H, 598, 600B, or any other applicable chapter.
  1.  An order or judgment that provides for temporary or permanent support for a child shall include a provision for medical support for the child as provided in this section.
  2.  The court shall order as medical support for the child a health benefit plan if available to either parent at the time the order is entered or modified. A plan is available if the plan is accessible and the cost of the plan is reasonable.
  a.  The cost of a health benefit plan is considered reasonable, and such amount shall be stated in the order, if one of the following applies:
  (1)  The premium cost for a child to the parent ordered to provide the plan does not exceed five percent of that parent’s gross income or the child support guidelines established pursuant to section 598.21B specifically provide an alternative income-based numeric standard for determining the reasonable cost of the premium, in which case the reasonable cost of the premium as determined by the standard specified by the child support guidelines shall apply.
  (2)  The premium cost for a child exceeds the amount specified in subparagraph (1) and that parent consents or does not object to entry of that order.
  b.  For purposes of this section, “gross income” has the same meaning as gross income for calculation of support under the guidelines established under section 598.21B.
  c.  For purposes of this section, “the premium cost for a child to the parent” ordered to provide the plan means the amount of the premium cost for family coverage to the parent which is in excess of the premium cost for single coverage, regardless of the number of individuals covered under the plan. However, this paragraph shall not be interpreted to reduce the amount of the health insurance premium deduction a parent may be entitled to when calculating the amount of a child support obligation under Iowa court rule 9.5 of the child support guidelines.
  3.  If a health benefit plan is not available at the time of the entry of the order, the court shall order a reasonable monetary amount in lieu of a health benefit plan, which amount shall be stated in the order. For purposes of this subsection, a reasonable amount means five percent of the gross income of the parent ordered to provide the monetary amount for medical support or, if the child support guidelines established pursuant to section 598.21B specifically provide an alternative income-based numeric standard for determining the reasonable amount, a reasonable amount means the amount as determined by the standard specified by the child support guidelines. This subsection shall not apply in any of the following circumstances:
  a.  If the parent’s monthly support obligation established pursuant to the child support guidelines prescribed by the supreme court pursuant to section 598.21B is the minimum obligation amount. If this paragraph applies, the court shall order the parent to provide a health benefit plan when a plan becomes available for which there is no premium cost for a child to the parent.
  b.  If subsection 7, paragraph “d”, “e”, or “f” applies.
  4.  If the court orders the custodial parent to provide a health benefit plan under subsection 2, the court may also order the noncustodial parent to provide a reasonable monetary amount in lieu of a health benefit plan. For purposes of this subsection, a reasonable monetary amount means an amount not to exceed the lesser of a reasonable amount as described in subsection 3, or the premium cost of coverage for the child to the custodial parent as described in subsection 2, paragraph “c”.
  5.  Notwithstanding the requirements of this section, the court may order provisions in the alternative to those provided in this section to address the health care needs of the child if the court determines that extreme circumstances so require and documents the court’s written findings in the order.
  6.  An order, decree, or judgment entered before July 1, 2009, that provides for the support of a child may be modified in accordance with this section.
  7.  If the child support recovery unit is providing services under chapter 252B and initiating an action to establish or modify support, all of the following shall also apply:
  a.  If a health benefit plan is available as described in subsection 2 to the noncustodial parent, the unit shall seek an order for the noncustodial parent to provide the plan.
  b.  If a health benefit plan is available as described in subsection 2 to the custodial parent and not to the noncustodial parent, the unit shall seek an order for the custodial parent to provide the plan.
  c.  If a health benefit plan is available as described in subsection 2 to each parent, and if there is an order for joint physical care, the unit shall seek an order for the parent currently ordered to provide a health benefit plan to provide the plan. If there is no current order for a health benefit plan for the child, the unit shall seek an order for the parent who is currently providing a health benefit plan to provide the plan.
  d.  If a health benefit plan is not available, and the noncustodial parent does not have income which may be subject to income withholding for collection of a reasonable monetary amount in lieu of a health benefit plan at the time of the entry of the order, the unit shall seek an order that the noncustodial parent provide a health benefit plan when a plan becomes available at reasonable cost, and the order shall specify the amount of reasonable cost as defined in subsection 2.
  e.  If a health benefit plan is not available, and the noncustodial parent is receiving assistance or is residing with any child receiving assistance as provided in section 252E.2A, subsection 1, paragraph “c”, subparagraph (3) or (4), the unit shall seek an order that the noncustodial parent shall provide a health benefit plan when a plan becomes available for which there is no premium cost for a child to the parent.
  f.  This section shall not apply to chapter 252H, subchapter IV.
2007 Acts, ch 218, §164, 187; 2008 Acts, ch 1019, §11 – 14, 18, 20

For transition provisions applicable to existing child support recovery unit rules, procedures, definitions, and requirements, and for nullification of 441 IAC rule 98.3, see 2007 Acts, ch 218, §186 

  252E.2  Order for medical support.
  1.  An order requiring the provision of coverage under a health benefit plan is authorization for enrollment of the dependent if the dependent is otherwise eligible to be enrolled. The dependent’s eligibility and enrollment for coverage under such a plan shall be governed by all applicable terms and conditions, including, but not limited to, eligibility and insurability standards. The dependent, if eligible, shall be provided the same coverage as the obligor.
  2.  An insurer who is subject to the federal Employee Retirement Income Security Act, as codified in 29 U.S.C. §  1169, shall provide benefits in accordance with that section which meet the requirements of a qualified medical child support order. For the purposes of this subsection “qualified medical child support order” means and includes a medical child support order as defined in 29 U.S.C. §  1169, or a child support order which creates or recognizes the existence of a child’s right to, or assigns to a child the right to, receive benefits for which a participant or child is eligible under a group health plan or a notice of such an order issued by the department, and which specifies the following:
  a.  The name and the last known mailing address of the participant and the name and mailing address of each child covered by the order except that, to the extent provided in the order, the name and mailing address of an official of the department may be substituted for the mailing address of the child.
  b.  A reasonable description of the type of coverage to be provided to each child, or the manner in which the type of coverage is to be determined.
  c.  The period during which the coverage applies.
  3.  The obligor shall take all actions necessary to enroll and maintain coverage under a health benefit plan for a dependent at the obligor’s present and all future places of employment.
  4.  A medical support order of a foreign jurisdiction may be entered or filed with the clerk of the district court. However, entry of such a medical support order under this subsection does not constitute registration of that medical support order.
90 Acts, ch 1224, §26; 92 Acts, ch 1195, §506; 93 Acts, ch 78, §21; 94 Acts, ch 1171, §26; 97 Acts, ch 175, §73; 98 Acts, ch 1170, §32; 2000 Acts, ch 1096, §2; 2002 Acts, ch 1018, §4

  252E.2A  Satisfaction of medical support order.
  This section shall apply if the child support recovery unit is providing services under chapter 252B.
  1.  Notwithstanding any law to the contrary and without a court order, a medical support order for a child shall be deemed satisfied with regard to the department, the child, the obligor, and the obligee for the period during which all of the following conditions are met:
  a.  The order is issued under any applicable chapter of the Code.
  b.  The unit is notified that the conditions of paragraph “c” are met and the parent ordered to provide medical support submits a written statement to the unit that the requirements of paragraph “c” are met.
  c.  The parent ordered to provide medical support meets at least one of the following conditions:
  (1)  The parent is an inmate of an institution under the control of the department of corrections or a comparable institution in another state.
  (2)  The parent’s monthly child support obligation under the guidelines established pursuant to section 598.21B is the minimum obligation amount.
  (3)  The parent is a recipient of assistance under chapter 239B or 249A, or under comparable laws of another state.
  (4)  The parent is residing with any child for whom the parent is legally responsible and that child is a recipient of assistance under chapter 239B, 249A, or 514I, or under comparable laws of another state. For purposes of this subparagraph, “legally responsible” means the parent has a legal obligation to the child as specified in Iowa court rule 9.7 of the child support guidelines.
  d.  The unit files a notice of satisfaction with the clerk of the district court. The effective date of the satisfaction shall be stated in the notice and the effective date shall be no later than forty-five days after the unit issues the notice of satisfaction.
  2.  If a medical support order is satisfied under subsection 1, the satisfaction shall continue until all of the following apply:
  a.  The unit is notified that none of the conditions specified in subsection 1, paragraph “c”, still applies.
  b.  The unit files a satisfaction termination notice that the requirements for a satisfaction under this section no longer apply. The effective date shall be stated in the satisfaction termination notice and the effective date shall be no later than forty-five days after the unit issues the satisfaction termination notice.
  3.  The unit shall mail a copy of the notice of satisfaction and the satisfaction termination notice to the last known address of the obligor and obligee.
  4.  The department of human services may match data for enrollees of the hawk-i program created pursuant to chapter 514I with data of the unit to assist the unit in implementing this section.
  5.  An order, decree, or judgment entered or pending on or before July 1, 2009, that provides for the support of a child may be satisfied as provided in this section.
2007 Acts, ch 218, §165, 187; 2008 Acts, ch 1019, §15 – 18, 20

For transition provisions applicable to existing child support recovery unit rules, procedures, definitions, and requirements, and for nullification of 441 IAC rule 98.3, see 2007 Acts, ch 218, §186 

  252E.3  Health benefit coverage of obligee.
  For cases for which services are being provided pursuant to chapter 252B, the order may require an obligor providing a health benefit plan for a child to also provide a health benefit plan for the benefit of an obligee if the obligee is eligible for enrollment under the plan in which the child or the obligor is enrolled, and if the plan is available at no additional cost.
90 Acts, ch 1224, §27

  252E.4  Order to employer.
  1.  When a support order requires an obligor to provide coverage under a health benefit plan, the district court or the department may enter an ex parte order directing an employer to take all actions necessary to enroll an obligor’s dependent for coverage under a health benefit plan or may include the provisions in an ex parte income withholding order or notice of income withholding pursuant to chapter 252D. The child support recovery unit, where appropriate, shall issue a national medical support notice to an employer within two business days after the date information regarding a newly hired employee is entered into the centralized employee registry and matched with a noncustodial parent in the case being enforced by the unit, or upon receipt of other employment information for such parent. The department may amend the information in the ex parte order or may amend or terminate the national medical support notice regarding health insurance provisions if necessary to comply with health insurance requirements including but not limited to the provisions of section 252E.2, subsection 2, or to correct a mistake of fact.
  2.  The obligee, district court, or department may forward either the support order containing the provision for coverage under a health benefit plan or the ex parte order provided for in subsection 1 to the obligor’s employer.
  3.  This chapter shall be constructive notice to the obligor of enforcement and further notice prior to enforcement is not required.
  4.  The order requiring coverage is binding on all future employers or insurers if the dependent is eligible to be enrolled in the health benefit plan under the applicable plan terms and conditions.
90 Acts, ch 1224, §28; 93 Acts, ch 78, §22; 96 Acts, ch 1141, §24; 97 Acts, ch 175, §74; 2002 Acts, ch 1018, §5; 2007 Acts, ch 218, §166, 187; 2008 Acts, ch 1019, §18, 20

For transition provisions applicable to existing child support recovery unit rules, procedures, definitions, and requirements, and for nullification of 441 IAC rule 98.3, see 2007 Acts, ch 218, §186 

  252E.5  Effect of order on employer.
  1.  When the order has been forwarded to the obligor’s employer pursuant to section 252E.4, the order is binding on the employer and the employer’s insurer to the extent that the dependent is eligible to be enrolled in the plan under the applicable terms and conditions of the health benefit plan and the standard enrollment guidelines of the insurer. The employer shall allow enrollment of the dependent at any time, notwithstanding any enrollment season restrictions. If a provision of this section conflicts with a provision in the national medical support notice, or in subsection 8, the provision in the notice and subsection 8 shall apply.
  2.  The employer shall forward a copy of the order to the insurer and request enrollment of the dependent in the health benefit plan. If the obligor fails to apply to obtain coverage for the dependent, the employer shall accept an application to enroll a dependent which has been signed by the obligee or other legal custodian of a child or by the department. Within sixty days of receipt of the order or within sixty days of receipt of application, whichever is earlier, the insurer shall determine whether the dependent is eligible for enrollment under the plan and shall notify the employer of the dependent’s eligibility status. If more than one plan is offered by the employer, the dependent shall be enrolled in the health benefit plan in which the obligor is enrolled. However, if more than one plan is offered to the obligor, the plan selected shall provide coverage which is accessible to the dependent.
  3.  The employer shall withhold from the employee’s compensation, the employee’s share, if any, of premiums for the health benefit plan in an amount that does not exceed the amount specified in the national medical support notice or order or the amount specified in 15 U.S.C. §  1673(b) and which is consistent with federal law. The employer shall forward the amount withheld to the insurer.
  4.  Within thirty days of receipt of an order that requires an obligor to enroll a dependent in a health benefit plan, the obligor’s employer shall provide the following information, as applicable, regarding the enrollment status of the dependent to the obligor, the obligee, or other legal custodian of the child, and the department:
  a.  That the dependent has been enrolled in a health benefit plan.
  b.  That the dependent is not eligible for enrollment and the reasons that the dependent is not eligible to be enrolled.
  c.  That the order has been forwarded to the insurer and a determination of eligibility for enrollment has not been made.
  5.  If the dependent has been enrolled in a health benefit plan, all of the following information shall be provided:
  a.  The name of the insurer providing the health benefit plan.
  b.  The dependent’s effective date of coverage.
  c.  The health benefit plan or account number.
  d.  The type of health benefit plan under which the dependent has been enrolled, including whether dental, optical, office visits, and prescription drugs are covered services. Additionally, the response shall include a brief description of the applicable deductibles, coinsurance, waiting periods for preexisting medical conditions, and other significant terms or conditions which materially affect the coverage.
  6.  a.  An employer shall not revoke enrollment or eliminate coverage for a dependent unless the employer is provided with satisfactory written evidence that one of the following conditions exists:
  (1)  A court or administrative order requiring coverage in a health benefit plan is no longer in effect.
  (2)  The dependent is eligible for or will be enrolled in a comparable health benefit plan which will take effect no later than the effective date of revocation of enrollment in the other plan.
  (3)  The employer has eliminated dependent health coverage for all employees.
  b.  Nothing in this section requires an employer to maintain coverage for the dependent if the premiums are no longer being paid by the obligor because the employer no longer owes compensation to the obligor or because the obligor’s employment has been terminated and the obligor has not elected to continue coverage.
  c.  If an order requiring that the obligor provide coverage under a health benefit plan for the dependent has been forwarded to the obligor’s employer pursuant to section 252E.4, and the obligor’s employment is terminated, the employer shall provide notice to the obligee and the department within ten days of termination of the obligor’s employment.
  7.  If an order requiring that the obligor provide coverage under a health benefit plan for the dependent has been forwarded to the obligor’s employer pursuant to section 252E.4, and the employer’s health benefit plan is terminated either in its entirety or with respect to the obligor’s insurance classification, or the employer has changed its insurer or become self-insured, the employer shall provide notice to the obligee or other legal custodian of the child and the department ten days prior to the termination or change in insurer.
  8.  If the department issues a national medical support notice to an employer or plan administrator, all of the following shall apply:
  a.  The employer and plan administrator shall comply with the provisions in the notice.
  b.  The employer and the plan administrator shall treat the notice as an application by the department for health benefit plan coverage for the dependent to the extent such application is required by the health benefit plan.
  c.  If the obligor named in the notice is not an employee of the employer, or if a health benefit plan is not offered or available to the employee, the employer shall notify the department, as provided in the notice, within twenty business days after the date of the notice.
  d.  If a health benefit plan is offered or available to the employee, the employer shall send the plan administrator’s portion of the notice to each appropriate plan administrator within twenty business days after the date of the notice.
  e.  Upon notification from the plan administrator that the dependent is enrolled, the employer shall either withhold and forward the premiums as provided in subsection 3, or shall notify the department that the enrollment cannot be completed due to limits established for withholding as provided in subsection 3.
  f.  If the plan administrator notifies the employer that the obligor is subject to a waiting period that expires more than ninety days from the date of receipt of the notice by the plan administrator or that the obligor is subject to a waiting period that is measured in a manner other than the passage of time, the employer shall notify the plan administrator when the obligor becomes eligible to enroll in the plan and that the notice requires enrollment in the plan of the dependent named in the notice.
  g.  The plan administrator shall enroll the dependent, and if necessary to enrollment of the dependent shall also enroll the obligor, in the plan selected in accordance with this paragraph. All of the following shall apply to the selection of the plan:
  (1)  If the obligor is enrolled in a health benefit plan that offers dependent coverage, that plan shall be selected.
  (2)  If the obligor is not enrolled in a plan or is not enrolled in a plan that offers dependent coverage, and if only one plan with dependent coverage is offered by the employer, that plan shall be selected.
  (3)  If the obligor is not enrolled in a health benefit plan or is not enrolled in a health benefit plan that offers dependent coverage, if more than one plan with dependent coverage is offered by the employer, and if the notice is issued by the child support recovery unit, all of the following shall apply:
  (a)  If only one of the plans is accessible to the dependent, that plan shall be selected. If none of the plans with dependent coverage is accessible to the dependent, the unit shall amend or terminate the notice.
  (b)  If more than one of the plans is accessible to the dependent, the plan selected shall be the plan that provides basic coverage for which the employee’s share of the premium is lowest.
  (c)  If more than one of the plans is accessible to the dependent but none of the accessible plans provides basic coverage, the plan selected shall be a plan that is accessible and for which the employee’s share of the premium is lowest.
  (d)  If the employee’s share of the premiums is the same under all plans described in subparagraph (b) or (c), the unit shall attempt to consult with the obligee when selecting the plan. If the obligee does not respond within ten days of the unit’s attempt, the unit shall select a plan which shall be the plan’s default option, if any, or the plan with the lowest deductibles and copayment requirements.
  (4)  If the obligor is not enrolled in a health benefit plan or is not enrolled in a health benefit plan that offers dependent coverage, if more than one plan with dependent coverage is offered by the employer, and if the notice is issued by the child support enforcement agency of another state, that agency shall select the plan as provided in paragraph “h”, subparagraph (3).
  h.  Within forty business days after the date of the notice, the plan administrator shall do all of the following as directed by the notice:
  (1)  Complete the appropriate portion of the notice and return the portion to the department.
  (2)  If the dependent is or is to be enrolled, notify the obligor, the obligee, and the child and furnish the obligee with necessary information. Provide the child support recovery unit with the type of health benefit plan under which the dependent has been enrolled, including whether dental, optical, office visits, and prescription drugs are covered services.
  (3)  If more than one health benefit plan is available to the obligor and the obligor is not enrolled, forward plan descriptions and documents to the department and enroll the dependent, and if necessary the obligor, in the plan selected by the department or in any default option if the plan administrator has not received a selection from the department within twenty business days of the date the plan administrator returned the national medical support notice response to the department.
  (4)  If the obligor is subject to a waiting period that expires more than ninety days from the date of receipt of the notice by the plan administrator or if the obligor has not completed a waiting period that is measured in a manner other than the passage of time, notify the employer, the department, the obligor, and the obligee. Upon satisfaction of the period or requirement, complete the enrollment.
  (5)  Upon completion of the enrollment, notify the employer for a determination of whether the necessary employee share of the premium is available.
  (6)  If the plan administrator is subject to the federal Employee Retirement Income Security Act, as codified in 29 U.S.C. §  1169, or is subject to the federal Child Support Performance and Incentive Act of 1998, Pub. L. No. 105-200, §  401, subsection (e) or (f), and the plan administrator determines the notice does not constitute a qualified medical child support order, complete and send the response to the department and notify the obligor, the obligee, and the child of the specific reason for the determination.
  9.  This chapter does not preclude the exchange of required information between the department and employers or insurers through electronic data transfer.
90 Acts, ch 1224, §29; 94 Acts, ch 1171, §27; 2002 Acts, ch 1018, §6, 7; 2009 Acts, ch 15, §2; 2009 Acts, ch 41, §263

  252E.6  Duration of health benefit plan coverage.
  1.  A child is eligible for medical support for the duration of the obligor’s child support obligation. However, the child’s eligibility for coverage under a health benefit plan shall be governed by all applicable plan provisions including, but not limited to, eligibility and insurability standards.
  2.  For cases for which services are being provided pursuant to chapter 252B, the department shall notify the employer when there is no longer a current order for medical support in effect for which the department is responsible. However, termination of medical support ordered pursuant to section 252E.3 shall be governed by the insurer’s health benefit plan provisions for termination and by applicable federal law.
90 Acts, ch 1224, §30; 2002 Acts, ch 1018, §8

  252E.6A  Motion to quash.
  1.  An obligor may move to quash the order to the employer under section 252E.4 by following the same procedures and alleging a mistake of a fact as provided in section 252D.31 or as provided in subsection 2. If the unit is enforcing an income withholding order and a medical support order simultaneously, any challenge to the income withholding order and medical support enforcement shall be filed and heard simultaneously.
  2.  The obligor may allege as a mistake of fact an error in the availability of dependent coverage under the health benefit plan because the coverage is not accessible to the dependent. Even if the plan is not accessible as defined in section 252E.1, the court may determine that the plan is substantially accessible if the obligee demonstrates that the dependent may receive a benefit under the plan. Section 252K.316 relating to evidence and procedure shall apply to the court proceeding.
  3.  The employer shall comply with the requirements of this chapter until the employer receives notice that a motion to quash has been granted, or that the unit has amended or terminated the national medical support notice.
97 Acts, ch 175, §75; 2002 Acts, ch 1018, §9

  252E.7  Insurer authorization.
  1.  The entry of an order requiring a health benefit plan is authorization for enrollment of the dependent if the dependent is otherwise eligible to be enrolled. If the obligor fails to obtain coverage for a dependent, the insurer shall accept the signature of the obligee or other legal custodian of the child or of an employee of the department on the application for enrollment of the dependent under the health benefit plan. If the dependent is otherwise eligible to be enrolled in the plan pursuant to the applicable terms and conditions of the health benefit plan and the standard enrollment guidelines of the insurer, the insurer shall allow enrollment of the dependent at any time, notwithstanding any enrollment season restrictions.
  2.  An insurer shall not deny enrollment of a child under the health benefit plan of the obligor based on any of the following:
  a.  The child was born out of wedlock.
  b.  The child is not claimed as a dependent on the obligor’s federal income tax form.
  c.  The child does not reside with the obligor or in the insurer’s service area.
  3.  For purposes of processing claims for payment, the insurer shall accept the signature of the obligee or other legal custodian of the child or of an employee of the department as valid authorization for purposes of processing any medical expense claims on behalf of the dependent for payment or reimbursement of medical services rendered to the dependent.
  4.  The insurer shall have immunity from any liability, civil or criminal, which might otherwise be incurred or imposed for actions taken in implementing this section including, but not limited to, the insurer’s release of any information, or the payment of any claims for services by the insurer, or the insurer’s acceptance of applications for enrollment of the dependent and medical expense claims for the dependent which are signed by the obligee or an employee of the department pursuant to this section.
  5.  If a dependent has coverage under the health benefit plan of and through the insurer of the obligor, the insurer shall make payment directly to the obligee, the provider, or the department for claims submitted by the obligee, by the provider with the obligee’s approval, or by the department.
  6.  Payments remitted to the obligor by the insurer for services received by the dependent shall be recoverable by the obligee or the department from the obligor if not properly paid by the obligor to the provider or the obligee.
90 Acts, ch 1224, §31; 94 Acts, ch 1171, §28

  252E.8  Releases of information.
  1.  If an order for coverage under a health benefit plan has been forwarded pursuant to section 252E.5, the obligor’s employer or insurer shall release to the obligee or other legal custodian of the child or the department, upon receiving a written request, the information necessary to complete an application, to file a claim for medical expenses of the dependent or to create a qualified medical child support order pursuant to section 252E.2, subsection 2.
  2.  The employer or insurer shall make available to the obligee or the department any necessary claim forms or enrollment membership cards if required to obtain services.
  3.  The obligor’s employer and insurer shall have immunity from any liability, civil or criminal, which might otherwise be incurred or imposed for any information released by such employer or insurer pursuant to this chapter.
  4.  The department may release to the obligor’s employer or insurer or to the obligee information necessary to obtain, enforce, and collect medical support.
90 Acts, ch 1224, §32; 94 Acts, ch 1171, §29

  252E.9  Responsibilities of the obligor.
  1.  For cases for which services are being provided pursuant to chapter 252B, an obligor who fails to maintain medical support for the benefit of the dependent as ordered shall be liable to the obligee or the department for any medical expenses incurred from the date of the court order. Proof of failure to maintain medical support constitutes a showing of increased need and provides a basis for the establishment of a monetary amount for medical support.
  2.  For cases for which services are being provided pursuant to chapter 252B, the obligor shall notify the obligee and the department within ten days of a change in the terms or conditions of coverage under a health benefit plan. Such changes may include, but are not limited to, a change in deductibles, coinsurance, preadmission notification requirements, coverage for dental, optical, office visits, prescription drugs, inpatient and outpatient hospitalization, and any other changes which materially affect the coverage. Costs incurred by the obligee or the department as a result of the obligor’s failure to provide notification as required are recoverable from the obligor.
90 Acts, ch 1224, §33

  252E.10  Responsibility of the department.
  For cases for which services are being provided pursuant to chapter 252B, the department shall take steps required by federal regulations to implement and enforce an order for medical support.
90 Acts, ch 1224, §34

  252E.11  Assignment.
  If medical assistance is provided by the department to a dependent pursuant to chapter 249A, rights to medical support payments are assigned to the department.
90 Acts, ch 1224, §35; 93 Acts, ch 78, §23

  252E.12  Enforcement.
  For the purposes of enforcement pursuant to chapter 252B, medical support may be reduced to a dollar amount and may be collected through the same remedies available for the collection and enforcement of child support.
90 Acts, ch 1224, §36

  252E.13  Modification of support order.
  1.  Subject to 28 U.S.C. §  1738B, when high potential for obtaining medical support exists, the obligee or the department may petition for a modification of the obligor’s support order to include medical support or a monetary amount for medical support pursuant to this chapter.
  2.  In addition, if a support order does not provide medical support as defined in this chapter or equivalent medical support, the department or a party to the order may seek a modification of the order.
  3.  Subject to 28 U.S.C. §  1738B, the department may amend information concerning the provisions regarding health benefits in a court or administrative order if notice of the amendment is provided to the court and to the parties to the order and if the amendment is filed with the clerk of court.
90 Acts, ch 1224, §37; 94 Acts, ch 1171, §30; 96 Acts, ch 1141, §25; 97 Acts, ch 175, §76

  252E.14  Child support.
  Unless the order specifies otherwise, medical support is not included in the monetary amount of child support ordered to be paid for orders entered on or after July 1, 1990.
90 Acts, ch 1224, §38

  252E.15  Rulemaking authority — compliance.
  The department shall adopt rules pursuant to chapter 17A to implement this chapter for cases for which services are being provided pursuant to chapter 252B. The department shall cooperate with any agency of the state or federal government as may be necessary to qualify for federal funds in conformity with provisions of this chapter and Tit. IV-D of the federal Social Security Act.
90 Acts, ch 1224, §39; 2010 Acts, ch 1061, §180

  252E.16  Scope and effect.
  1.  The provisions of this chapter take effect July 1, 1990, for all support orders entered pursuant to chapter 234, 252A, 252C, 598, or 600B.
  2.  If an obligor was ordered to provide a health benefit plan or insurance coverage under an order entered prior to July 1, 1990, but did not comply with the order, insurers are not liable for medical expenses incurred prior to July 1, 1990. However, such an order may be implemented pursuant to the provisions of this chapter following its enactment. This chapter shall not be implemented retroactively; however, previous orders for medical support not otherwise complied with may be reduced to a dollar amount and collected from the obligor.
90 Acts, ch 1224, §40