Form M300 Mewa Coverage Requirements 760 (Page 2 of 4) in pdf

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(A) at least fifty (50) years of age; or

(B) younger than fifty (50) years of age and at high risk for prostate cancer

according to the most recent published guidelines of the American Cancer

Society.

(3) Colorectal cancer examinations and laboratory tests for cancer for any

nonsymptomatic insured, in accordance with the current American Cancer

Society guidelines for a covered individual who is:

(A) fifty (50) years of age; or

(B) less than fifty (50) years of age and at high risk for colorectal cancer

according to the most recent published guidelines of the American Cancer

Society.

760 IAC 1-68-4(n) A MEWA may not deny enrollment of a child of a covered

individual because the child was born out of wedlock, the child is not claimed as a

dependent on the parent's federal income tax return, or the child does not reside with

the parent or in the MEWA's service area. Whenever a child of a noncustodial parent

is eligible for coverage with or covered by the MEWA, the MEWA shall do the

following:

(1) Provide any information to the custodial parent that is necessary for the child

to obtain benefits through the MEWA.

(2) Permit the custodial parent, or the provider of medical services with the

custodial parent's approval, to submit claims for covered services without the

approval of the noncustodial parent.

(3) Make payments on insurance claims submitted under subdivision (2) directly

to the:

(A) custodial parent;

(B) provider of the medical services; or

(4) When a parent is required by a court or an administrative order to provide

health coverage for a child and the parent is

eligible for family health coverage with the MEWA, the MEWA must do all of the

following:

(A) Permit the parent to enroll under the family coverage a child who is

otherwise eligible for the coverage, without regard to any enrollment season

restriction.

(B) Enroll a child under the family coverage upon application by:

(i) the child's custodial parent;

(ii) the office of Medicaid policy and planning; or

(iii) a Title IV-D agency whenever a noncustodial parent who is enrolled

fails to apply for coverage of the child.

otherwise eligible for coverage unless the MEWA is provided satisfactory written

evidence that the:

(i) court order or administrative order is no longer in effect; or

(ii) child is or will be enrolled in comparable health coverage not later

than the effective date of the disenrollment.

760 IAC 1-68-4(o) If the MEWA coordinates benefits, the coordination of benefits

provision must comply with 760 IAC 1-38.1.

760 IAC 1-68-16(a) A MEWA shall provide to each participating employer the written

notice, "In the event the plan or the MEWA does not ultimately pay medical expenses

that are eligible for payment under the plan for any reason, the participating employer

may be liable for those expenses."

Form M300 Mewa Coverage Requirements 760 Page 2

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