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LastUpdated:March5,2015MARATHONPETROLEUMCOMPANY-QUALIFIEDMEDICALCHILDSUPPORTORDER("QMCSO")PROCEDURESThisdocumentsetsforththeprocedurestobefollowedbyMarathonPetroleumCompanyLP's("MPC")grouphealthplansuponreceiptofqualifiedmedicalchildsupportorders("QMCSO's"),includinganyNationalMedicalSupportNotices("NMSN's").
1.
WhatisaQMCSOandwhodecideswhethertheorderis"qualified"AQMCSOisajudgment,decree,ororder,issuedbyacourtorthroughastateadministrativeprocess,thatrequiresgrouphealthplancoverageforthechildofaplanparticipant(calledan"alternaterecipient"),andmeetscertainlegalrequirements.
Suchorderstypicallyareissuedaspartofadivorceoraspartofastatechildsupportorderproceeding.
ThePlanAdministratorfortheapplicableplandetermineswhetheramedicalchildsupportorder(includingNMSN's)meetstherequirementsfortreatmentasaQMCSO.
ThePlanAdministratorfortheMPCgrouphealthplanshasdesignatedcertainindividualswithintheMPCBenefitsServiceCentertoreceiveallmedicalchildsupportordersandNMSN'sdeliveredtoMPCandtofollowtheseprocedures.
2.
WhatisaNationalMedicalSupportNotice("NMSN")CertainstatechildsupportenforcementagenciesarerequiredbyfederallawtousetheNationalMedicalSupportNoticewhenenforcingtheprovisionofhealthcarecoveragetochildrenunderanemployment-relatedgrouphealthplan.
Whenproperlycompleted,theNMSNwillconstituteaQMCSO.
3.
WhatproceduresarefolloweduponreceiptofamedicalchildsupportorderorNMSNThePlanAdministratorordesigneewillpromptlynotifytheplanparticipantandeachalternaterecipient(attheaddressspecifiedintheorder),andanylegalrepresentatives,ofthereceiptoftheorder/NoticeandprovideacopyoftheseQMCSOprocedures.
ThePlanAdministratorordesigneewillreviewtheordertodetermineifitmeetsthelegalrequirementsofaQMCSO.
Within40businessdaysafterreceiptoftheorderorNotice,orsoonerifreasonable,thePlanAdministratorordesigneewillnotifytheplanparticipantandalternaterecipient(andanylegalrepresentatives)thateither:(a)theorderisaQMSCO;or(b)theorderisnotaQMCSO,alongwithanexplanationofthedefectiveormissingprovisions.
ForLastUpdated:March5,2015NMSN's,thestateagencyandanyotherpartiesindicatedintheNoticewillalsobenotified,usingthespacesindicatedontheNotice.
ForNMSN's,thePlanAdministratorordesigneewillcompleteandfollowtheinstructionsprovidedinthe"PlanAdministratorResponse"sectionoftheNotice.
IftheorderorNMSNisdeterminedtobeaQMCSO,additionalinformationwillbeprovided,suchastheeffectivedateofthechild'scoverage,thestepsnecessarytoeffectuatecoverage,adescriptionofthecoverage,andanyformsordocumentsnecessaryforplanenrollment.
4.
WhataretheproceduresfordeterminingwhethermedicalchildsupportordersandNMSN'sareQMCSO'sThePlanAdministratorordesigneewillreviewmedicalchildsupportordersandNMSN'stodeterminewhethertheorderorNotice–Isajudgment,decree,ororder(includingapprovalofasettlementagreement)whichprovidesforchildsupportwithrespecttoachildofagrouphealthplanparticipantorprovidesforhealthbenefitcoveragetosuchachild,andismadepursuanttoastatedomesticrelationslaw(includingacommunitypropertylaw),andrelatestobenefitsundersuchplan,orismadepursuanttoalawrelatingtomedicalchildsupportdescribedinsection1908oftheSocialSecurityActwithrespecttoagrouphealthplan.
Createsorrecognizestheexistenceofanalternaterecipient'srightto,orassignstoanalternaterecipienttherightto,receivebenefitsforwhichaparticipantorbeneficiaryiseligibleunderagrouphealthplan.
Specifiesthenameandlastknownmailingaddressoftheplanparticipantandthenameandmailingaddressofeachalternaterecipient(thenameandmailingaddressofanofficialofaStateorapoliticalsubdivisionthereofmaybesubstitutedforthemailingaddressofanyalternaterecipient).
Includesareasonabledescriptionofthetypeofcoveragetobeprovidedbytheplantoeachalternaterecipient,andtheperiodtowhichsuchorderapplies.
Doesnotrequiretheplantoprovideanytypeorformofbenefit,oranyoption,nototherwiseprovidedundertheplan,excepttotheextentnecessarytomeettherequirementsofalawrelatingtomedicalchildsupportdescribedinsection1908oftheSocialSecurityAct.
LastUpdated:March5,20155.
WhataretheproceduresforadministeringtheprovisionofbenefitsunderQMSCO'sEachalternaterecipientunderaQMCSOwillbetreatedasabeneficiaryundertheplanforallpurposesofERISA,specificallyincludingERISA'sreportinganddisclosurerequirements(i.
e.
,receiptofsummaryplandescriptionsandsummariesofmaterialmodifications).
Thealternaterecipientwillbeadded(orwillremain)asadependentoftheplanparticipantforpurposesofmembercontributionsanddeductibles.
PaymentforbenefitsmadebyagrouphealthplanpursuanttoaQMCSOinreimbursementforexpensespaidbyanalternaterecipientoranalternaterecipient'scustodialparentorlegalguardianshallbemadetothealternaterecipientorthealternaterecipient'scustodialparentorlegalguardianortoanofficialofaStateorpoliticalsubdivisionthereofwhosenamesandaddresshavebeensubstitutedfortheaddressofanalternaterecipientinaQMCSO.
6.
DesignationofRepresentativeAlternaterecipientsmaydesignatearepresentativeforreceiptofcopiesofnoticesthataresenttothealternaterecipient.