21 Million Children’s Health:
Our Shared Responsibility

The Medical Child Support Working Group’s Report

APPENDIX B:
Glossary

Beneficiary

A person designated by a participant, or by the terms of an employee benefit plan, who is or may become entitled to a benefit thereunder. (ERISA §3(8), 29 USC 1002(8)).

Child Support-Eligible Children

Children whose parents have divorced, separated, or decided not to marry or live together. Not all child support-eligible children live in single-parent households; about 20 percent live in married step-parent families. Some child support-eligible children live with neither parent, staying instead with a guardian or in placement through foster care.

Cost Avoidance

A method of avoiding payment of Medicaid claims when other insurance resources are available to the Medicaid beneficiary. Whenever the Medicaid agency is billed first, claims are denied and returned to the provider who is required to bill and collect from liable third parties. Cost avoidance also includes payment avoided when the provider bills the third party first.

Custodial Parent

Person with legal custody and with whom the child lives; may be parent, other relative, or someone else. Sometimes called obligee.

Group Health Plan

An employee welfare benefit plan that provides medical, surgical, hospital, or other health care benefits to participants or beneficiaries directly or through insurance, reimbursement, or otherwise (ERISA §607(1), 29 USC 1167(1)).

Guidelines

A standard method for setting child support obligations based on the income of the parent(s) and other factors as determined by State law.

IV-D Program

The Federal child support enforcement program, as established under Part D of Title IV of the Social Security Act. The IV-D program provides Federal funds to State Child Support Enforcement services operating under the Federal IV-D statute, regulations, and rules. Individuals who are receiving public assistance are required to cooperate with the IV-D program to establish and enforce a child support order. Individuals who are not receiving public assistance may participate in the IV-D program by completing an application, and may be required to pay a nominal application fee, no greater than $25.

IV-D Child Support Orders

Child support orders that are enforced by the State child support enforcement agency that must follow the requirements of Title IV-D of the Social Security Act.

Insured Plan

An employee welfare benefit plan under which benefits are provided through a contract or policy between the plan and an insurance company, HMO, or similar entity. The policies or contracts through which such plans provide benefits, as well as the insurance company, HMO or similar entity, are subject to State insurance laws.

Liable Third Party

Any individual, entity, or program that is, or may be, liable to pay all or part of the medical cost of any medical assistance furnished to a beneficiary under the approved State plan. This includes a group health plan as defined in §607(a) of ERISA, a service benefit plan, and a health maintenance organization.

Medicaid

A jointly-funded, Federal-State health insurance program for certain low-income and needy people. It covers approximately 36 million individuals including children, the aged, blind and/or disabled, and people who are eligible to receive Federally-assisted income maintenance payments.

Medical Child Support Order

A judgment, decree, or order issued by a court or administrative agency, including an administrative notice issued by such an agency, which has the force and effect of law, that provides for child support with respect to a child of a participant in a group health plan or provides for health benefit coverage to such child and relates to benefits under such plan. Generally, a "medical child support order" is the medical support component of a broader order for child support. (ERISA § 609(a)(2)(B), 29 USC § 1169(a)(2)(B))

Medical Support

Legal provision for payment of medical and dental bills. Can be either family health coverage or cash medical support. Note: States vary widely on what type of medical bills are included in this definition.

Multiemployer Plan

A plan to which more than one employer is required to contribute that is maintained pursuant to one or more collective bargaining agreements between one or more employee organizations (generally, unions) and more than one employer. Such plans are also subject to certain rules of the Labor Management Relations Act. They are established and maintained pursuant to a joint board of trustees that is composed of equal numbers of employer and union trustees. Generally, contributions are made by employers pursuant to a formula contained in the collective bargaining agreement(s) based on the number of hours worked by union employees of the signatory employers. (ERISA §3(38)(A), 29 USC 1002(37)(A))

Noncustodial Parent

Parent who does not have primary custody of a child. Sometimes called obligor. Also known as "participant" for family health coverage purposes.

Order

Direction of a magistrate, judge, or properly empowered administrative officer.

Participant

An employee or former employee of employer, or a member or former member of an employee organization, who is or may become eligible to receive a benefit of any type from an employee benefit plan that covers employees of such employer or members of such organization, or whose beneficiaries may be eligible to receive any such benefit. (ERISA §3(7), 29 USC 1002(7))

Pay and Chase

A method used in which Medicaid pays the beneficiary's medical bills and then attempts to recover from liable third parties.

Plan Administrator

The administrator of a plan is the person specifically so designated by the plan's organizational documents. If no administrator is specifically designated, then the administrator of the plan is the plan's sponsor. The plan administrator has several specific responsibilities under ERISA with respect to plan administration. (ERISA §3(16)(A), 29 USC 1002(16)(A))

Plan Fiduciary

ERISA generally defines a fiduciary to include someone with discretionary authority with respect to the administration of a plan, or the management of a plan or its assets. (ERISA §3(21), 29 USC 1002(21))

Plan Sponsor

For a plan that is established or maintained by an employer or employee organization, the sponsor is the employer or employee organization. For a plan that is established or maintained by two or more employers or jointly by one or more employers and one or more employee organizations, the sponsor is the joint board or trustees or similar group of representatives of the parties who establish or maintain the plan. (ERISA §3(16)(B), 29 USC 1002(16)(B))

Preemption

In general, the doctrine that certain matters, either implicitly or by explicit expression of Congress, are of such a national, as opposed to local, character, that Federal laws supercede or take precedence over State laws. ERISA has a very broad explicit preemption of any State law that "relates to" an employee benefit plan, whether or not the State law conflicts with ERISA. (ERISA §514(a), 29 USC 1144(a))

Qualified Domestic Relations Order (QDRO)

A domestic relations order which creates or recognizes the existence of an alternate payee's right to receive, or assigns to an alternate payee the right to receive, all or a portion of the benefits payable with respect to a participant under a pension plan, and that includes certain information and meets certain other statutory requirements. An alternate payee is a spouse, former spouse, child, or other dependent of the participant. (ERISA §206(d)(3), 29 USC 1056(d)(3))

Qualified Medical Child Support Order (QMCSO)

A medical child support order which creates or recognizes the existence of an alternate recipient's right to receive benefits for which a participant or beneficiary is eligible under a group health plan, and that includes certain information and meets certain other statutory requirements. An alternate recipient is a child of a participant who is recognized under a medical child support order as having a right to enrollment under a group health plan with respect to the participant. (ERISA §609(a)(2), 29 USC 1169(a)(2))

Self-Insured Plan

An employee welfare benefit plan under which all benefits are paid either from the general assets of the sponsor of the plan, or from a trust into which the sponsor and/or participants have made contributions. Such plans generally are exempt from State law.

State Children's Health Insurance Programs (SCHIP)

The Balanced Budget Act of 1997 created a new children's health insurance program under Title XXI of the Social Security Act which enables States to initiate and expand health insurance for uninsured children with family incomes too high for Medicaid but too low to afford private family coverage. The law allows States to expand coverage for children through a separate child health insurance program, through the Medicaid program, or through a combination of these programs.

Temporary Assistance for Needy Families (TANF)

Time-limited assistance payments to poor families. The TANF program provides parents with job preparation, work, and support services to help them become self-sufficient.

Uniform Reciprocal Enforcement Of Support Act And Uniform Interstate Family Support Act (URESA and UIFSA)

Laws enacted at the State level that provide mechanisms for establishing and enforcing support obligations when the noncustodial parent lives in one State and the custodial parent and child(ren) live in another State.

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Last updated: 11/17/00