Guam § 95101 - Coverage of Children.

§ 95101. Coverage of Children.

(a) An insurer shall not deny enrollment of a child under the health

plan of the child=s parent on the grounds that:

(1) The child was born out of wedlock;

(2) The child is not claimed as a dependent on the parent=s Guam

tax return;

(3) The child does not reside with the parent or in the insurer=s

service area;

(4) The child has a pre-existing or excluded medical condition; or

(5) The child is adopted or is the subject of adoption proceedings.

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(b) Where a child has health coverage through an insurer of a

noncustodial parent the insurer shall:

(1) Provide such information to the custodial parent as may be

necessary for the child to obtain benefits through that coverage;

(2) Permit the custodial parent (or the provider, with the custodial

parent=s approval) to submit claims for covered services without the

approval of the noncustodial parent; and

(3) Make payments on claims submitted in accordance with

subparagraph (2) of this section directly to the custodial parent, the

provider or the state Medicaid agency.

(c) Where a parent is required by a court or administrative order to

provide health coverage for a child, and the parent is eligible for family

health coverage, the insurer shall be required:

(1) To permit the parent to enroll, under the family coverage, a

child who is otherwise eligible for the coverage without regard to any

enrollment season or open enrollment restrictions;

(2) If the parent is enrolled but fails to make application to obtain

coverage for the child, to enroll the child under family coverage upon

application of the child=s other parent, the local agency administering

the Medicaid program or the local agency administering ''651 to 669,

Title 42 United States Code, the child support enforcement program;

and

(3) Not to disenroll (or eliminate coverage of) the child unless the

insurer is provided satisfactory written evidence that:

(i) The court or administrative order is no longer in effect; or

(ii) The child is or will be enrolled in comparable health

coverage through another insurer which will take effect not later

than the effective date of disenrollment.

(d) An insurer may not impose requirements on a territorial agency,

which has been assigned the rights of an individual eligible for medical

assistance under Medicaid and covered for health benefits from the insurer,

that are different from requirements applicable to an agent or assignee of

any other individual so covered.