252EMEDICAL SUPPORT252E.1Definitions.As used in this chapter, unless the context otherwise requires:1“Accessible” means any of the following, unless otherwise provided in the support order:aThe health benefit plan does not have service area limitations or provides an option not subject to service area limitations.bThe 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 health care coverage 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“Cash medical support” means a monetary amount that a parent is ordered to pay to the obligee in lieu of that parent providing health care coverage, which amount is five percent of the gross income of the parent ordered to pay the monetary amount or, if the child support guidelines established pursuant to section 598.21B specifically provide an alternative income-based numeric standard for determining the amount, the amount determined by the standard specified by the child support guidelines. “Cash medical support” is 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. 4“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 another state or foreign country.5“Child support services” means child support services created in section 252B.2.6“Department” means the department of health and human services, which includes but is not limited to child support services, or any comparable support enforcement agency of another state.7“Dependent” means a child, or an obligee for whom a court may order health care coverage pursuant to section 252E.3.8“Enroll” means to be eligible for and covered by a health benefit plan.9“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 or organization, any public coverage, or any 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.10“Health care coverage” or “coverage” means providing and paying for the medical needs of a dependent through a health benefit plan. 11“Insurer” means any entity, including a health service corporation, health maintenance organization, or any similar corporation or organization, or an employer offering self-insurance, that provides a health benefit plan, but does not include an entity that provides public coverage.12“Medical support” means either the provision of health care coverage or the payment of cash medical support. “Medical support” is not alimony. 13“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 in accordance with section 252E.4 to enforce the health care coverage provisions of a support order. The national medical support notice is not applicable to a provider of public coverage.14“Obligee” means a parent or another natural person legally entitled to receive a support payment on behalf of a child.15“Obligor” means a parent or another natural person legally responsible for the support of a dependent.16“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 another state or foreign country, or an ex parte order entered pursuant to section 252E.4. “Order” also includes a notice of such an order issued by the department.17“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. “Plan administrator” does not include a provider of public coverage.18“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; an advanced registered nurse practitioner; or a physician assistant.19“Public coverage” means health care benefits provided by any form of federal or state medical assistance, including but not limited to benefits provided under chapter 249A or 514I, or under comparable laws of another state, foreign country, or Indian nation or tribe.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; 2015 Acts, ch 110, §100; 2018 Acts, ch 1111, §2, 10; 2019 Acts, ch 24, §29; 2023 Acts, ch 19, §895; 2023 Acts, ch 119, §24252E.1AEstablishing and modifying orders for medical support.1This 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. If an action to establish or modify an order for support is initiated by child support services, section 252E.1B shall also apply.2An 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.3The court shall order as medical support for the child health care coverage if a health benefit plan other than public coverage is available to either parent at the time the order is entered or modified. A health benefit plan is available if the plan is accessible and the cost of the plan is reasonable.aThe cost of a health benefit plan is considered reasonable, and such amount shall be stated in the order, if one of the following applies:1The premium cost for a child to the parent ordered to provide coverage 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.2The 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.bFor purposes of this section, “family coverage” means coverage that covers multiple individuals and covers or could cover the child or children subject to the child support order.cFor 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.dFor purposes of this section, “the premium cost for a child to the parent” ordered to provide coverage 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. 4If a health benefit plan other than public coverage is not available to either parent at the time of the entry of the order, and the custodial parent does not have public coverage for the child, the court shall order cash medical support in an amount which shall be stated in the order. This subsection shall not apply in any of the following circumstances:aIf 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 health care coverage when a plan becomes available for which there is no premium cost for a child to the parent.bIf the noncustodial parent does not have income which may be subject to income withholding for collection of cash medical support at the time of the entry of the order. If this paragraph applies, the court shall order the noncustodial parent to provide health care coverage when a health benefit plan becomes available at a reasonable cost, and the order shall specify the amount of the reasonable cost as specified in subsection 3, paragraph “a”, subparagraph (1).cIf 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). If this paragraph applies, the court shall order the noncustodial parent to provide health care coverage when a health benefit plan becomes available for which there is no premium cost for a child to the parent. 5If a health benefit plan other than public coverage is not available to either parent at the time of the entry of the order, and the custodial parent has public coverage for the child, the court shall order the custodial parent to provide health care coverage, and the court shall order the noncustodial parent to pay cash medical support, which amount shall be stated in the order, unless an exception under subsection 4 applies. 6Notwithstanding 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.7An order, decree, or judgment entered before October 1, 2018, that provides for the support of a child may be modified in accordance with this section.2007 Acts, ch 218, §164, 187; 2008 Acts, ch 1019, §11 – 14, 18, 20; 2018 Acts, ch 1111, §3, 10; 2023 Acts, ch 19, §896252E.1BEstablishing and modifying orders for medical support actions initiated by child support services.1If child support services is initiating an action to establish or modify support, this section shall apply in addition to the provisions of section 252E.1A.2Child support services shall apply the following order of priority when child support services enters or seeks an order for medical support:aIf the custodial parent is currently providing coverage for the child under a health benefit plan other than public coverage, and the plan is available as described in section 252E.1A, subsection 3, child support services shall enter or seek an order for the custodial parent to provide coverage.bIf the noncustodial parent is currently providing coverage for the child under a health benefit plan other than public coverage, and the plan is available as described in section 252E.1A, subsection 3, child support services shall enter or seek an order for the noncustodial parent to provide coverage. cIf a health benefit plan other than public coverage is available as described in section 252E.1A, subsection 3, to the custodial parent, child support services shall enter or seek an order for the custodial parent to provide coverage.dIf a health benefit plan other than public coverage is available as described in section 252E.1A, subsection 3, to the noncustodial parent, child support services shall enter or seek an order for the noncustodial parent to provide coverage.eIf a health benefit plan other than public coverage is not available to either parent, and the custodial parent has public coverage for the child, child support services shall enter or seek an order for the custodial parent to provide health care coverage and shall enter or seek an order for the noncustodial parent to pay cash medical support. However, if any of the circumstances described in section 252E.1A, subsection 4, paragraph “a”, “b”, or “c” is met, child support services shall enter or seek an order as specified by the applicable paragraph.3Notwithstanding subsection 2, if there is an order for joint physical care for the child and the parties subject to the support order, child support services shall apply the following order of priority when child support services enters or seeks an order for medical support:aIf only one parent is currently providing coverage for the child under a health benefit plan other than public coverage, and the plan is available as described in section 252E.1A, subsection 3, child support services shall enter or seek an order for that parent to provide coverage.bIf both parents are currently providing coverage for the child under a health benefit plan other than public coverage, and both plans are available as described in section 252E.1A, subsection 3, child support services shall enter or seek an order for both parents to provide coverage.cIf neither parent is currently providing coverage for the child under a health benefit plan other than public coverage, and a health benefit plan other than public coverage is available as described in section 252E.1A, subsection 3, to one parent, child support services shall enter or seek an order for that parent to provide coverage.dIf neither parent is currently providing coverage for the child under a health benefit plan other than public coverage, and a health benefit plan other than public coverage is available as described in section 252E.1A, subsection 3, to both parents, child support services shall enter or seek an order for both parents to provide coverage.eIf a health benefit plan other than public coverage is not available to either parent and one parent has public coverage for the child, child support services shall enter or seek an order for that parent to provide health care coverage.4Child support services or the court shall not order any modification to an existing medical support order in a proceeding conducted solely pursuant to chapter 252H, subchapter IV.2018 Acts, ch 1111, §4, 10; 2023 Acts, ch 19, §897252E.2Order for medical support.1An order requiring the provision of coverage under a health benefit plan other than public coverage 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.2An 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:aThe 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 the department may be substituted for the mailing address of the child.bA 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.cThe period during which the coverage applies.3The 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.4A medical support order of another state or foreign country 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; 2015 Acts, ch 110, §101; 2018 Acts, ch 1111, §5, 10; 2023 Acts, ch 19, §898252E.2ASatisfaction of medical support order.This section shall apply if child support services is providing services under chapter 252B.1Notwithstanding 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:aThe order is issued under any applicable chapter of the Code.bChild support services is notified that the conditions of paragraph “c” are met and the parent ordered to provide medical support submits a written statement to child support services that the requirements of paragraph “c” are met.cThe parent ordered to provide medical support meets at least one of the following conditions:1The parent is an inmate of an institution under the control of the department of corrections or a comparable institution in another state.2The parent’s monthly child support obligation under the guidelines established pursuant to section 598.21B is the minimum obligation amount.3The parent is a recipient of assistance under chapter 239B or 249A, or under comparable laws of another state.4The 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.dChild support services 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 child support services issues the notice of satisfaction.2If a medical support order is satisfied under subsection 1, the satisfaction shall continue until all of the following apply:aChild support services is notified that none of the conditions specified in subsection 1, paragraph “c”, still applies.bChild support services 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 child support services issues the satisfaction termination notice.3Child support services shall mail a copy of the notice of satisfaction and the satisfaction termination notice to the last known address of the obligor and obligee.4The department may match data for enrollees of the Hawki program created pursuant to chapter 514I with data of child support services to assist child support services in implementing this section.5An 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; 2023 Acts, ch 19, §899252E.3Health care coverage of obligee.For cases for which services are being provided pursuant to chapter 252B, the order may require an obligor providing health care coverage for a child to also provide health care coverage 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 coverage for the obligee is available at no additional cost.90 Acts, ch 1224, §27; 2018 Acts, ch 1111, §6, 10252E.4Order to employer.1When a support order requires an obligor to provide coverage under a health benefit plan other than public coverage, 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. Child support services, 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 child support services, 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.2The 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.3This chapter shall be constructive notice to the obligor of enforcement and further notice prior to enforcement is not required.4The 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; 2018 Acts, ch 1111, §7, 10; 2023 Acts, ch 19, §900252E.5Effect of order on employer.1When 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.2The 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.3The 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.4Within 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:aThat the dependent has been enrolled in a health benefit plan.bThat the dependent is not eligible for enrollment and the reasons that the dependent is not eligible to be enrolled.cThat the order has been forwarded to the insurer and a determination of eligibility for enrollment has not been made.5If the dependent has been enrolled in a health benefit plan, all of the following information shall be provided:aThe name of the insurer providing the health benefit plan.bThe dependent’s effective date of coverage.cThe health benefit plan or account number.dThe 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.6aAn 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:1A court or administrative order requiring coverage in a health benefit plan is no longer in effect.2The 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.3The employer has eliminated dependent health coverage for all employees.bNothing 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.cIf 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.7If 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.8If the department issues a national medical support notice to an employer or plan administrator, all of the following shall apply:aThe employer and plan administrator shall comply with the provisions in the notice.bThe 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.cIf 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.dIf 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.eUpon 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.fIf 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.gThe 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:1If the obligor is enrolled in a health benefit plan that offers dependent coverage, that plan shall be selected.2If 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.3If 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 child support services, all of the following shall apply:aIf 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, child support services shall amend or terminate the notice.bIf 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.cIf 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.dIf the employee’s share of the premiums is the same under all plans described in subparagraph (b) or (c), child support services shall attempt to consult with the obligee when selecting the plan. If the obligee does not respond within ten days of child support services’ attempt, child support services shall select a plan which shall be the plan’s default option, if any, or the plan with the lowest deductibles and copayment requirements.4If 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).hWithin forty business days after the date of the notice, the plan administrator shall do all of the following as directed by the notice:1Complete the appropriate portion of the notice and return the portion to the department.2If the dependent is or is to be enrolled, notify the obligor, the obligee, and the child and furnish the obligee with necessary information. Provide child support services 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.3If 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.4If 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.5Upon completion of the enrollment, notify the employer for a determination of whether the necessary employee share of the premium is available.6If 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.9This 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, §2632023 Acts, ch 19, §901, 902252E.6Duration of health benefit plan coverage.1A 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.2For 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, §8252E.6AMotion to quash.1An 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 child support services 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.2The 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.3The employer shall comply with the requirements of this chapter until the employer receives notice that a motion to quash has been granted, or that child support services has amended or terminated the national medical support notice.97 Acts, ch 175, §75; 2002 Acts, ch 1018, §92023 Acts, ch 19, §903252E.7Insurer authorization.1The 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.2An insurer shall not deny enrollment of a child under the health benefit plan of the obligor based on any of the following:aThe child was born out of wedlock.bThe child is not claimed as a dependent on the obligor’s federal income tax form.cThe child does not reside with the obligor or in the insurer’s service area.3For 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.4The 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.5If 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.6Payments 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, §28252E.8Releases of information.1If 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 2.2The 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.3The 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.4The 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, §29252E.9Responsibilities of the obligor.1For 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.2For 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, §33252E.10Responsibility 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, §34252E.11Assignment.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, §23252E.12Enforcement.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, §36252E.13Modification of support order.1Subject 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.2In 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.3Subject 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, §76252E.14Child 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, §38252E.15Rulemaking 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, §180252E.16Scope and effect.1Unless otherwise specified, the provisions of this chapter take effect July 1, 1990, for all support orders entered pursuant to chapter 234, 252A, 252C, 598, or 600B.2If 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; 2018 Acts, ch 1111, §8, 10