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Compliance August 27, 2007
Court Orders Wal-Mart to Provide Employee's Stepchild Medical Benefits
August 27, 2007 (PL.ANSPONSOR.com) - The U.S.
District Court for the Northern District of New York has
determined that a Qualified Medical Child Support Order
(QMCSO) can require an employer to cover an employee's
stepchild under its medical benefits plan even if the
stepchild would not normally be covered under the
plan.
Reported by Rebecca Moore
In its opinion, the court said Wal-Mart did not provide any legal support for the argument that a stepchild is distinct from a “child” as defined by the Employee Retirement Income Security Act (ERISA) or that cohabitation, legal guardianship, or tax status are relevant to the definition of “child” in this context. Wal-Mart admitted that “neither ERISA nor the Social Security Act defines the term ‘parent'” to exclude stepparents. The court said it was “not willing to presume without support that stepchildren are excluded from ERISA’s definition of an alternate recipient” under a QMCSO.
The court pointed out the law dictates that even a QMCSO cannot force a plan to provide a type of benefit not otherwise provided, unless it fits within the statutory exception for coverage “necessary to meet the requirements of a law relating to medical child support described in section 1908 of the Social Security Act [42 U.S.C. § 1396g-1],” and ruled the QMCSO under contemplation in this case fit within that exception.
The court said laws states must pass, pursuant to section 1908, prohibit health insurers from denying coverage of a child because the child does not reside with the employee/participant, because the child is not the participant’s dependant for tax matters, or because the child was born out of wedlock.
The New York statute also is silent on whether stepchildren are included in the definition of “children” under this law, but the plaintiffs in the case argued that the New York statute must be interpreted to include stepchildren because New York law expressly requires that stepparents are responsible for the support of children “in like manner” as natural parents, when the child is or is about to become a recipient of public assistance.
ERISA does not preempt the New York law mandating stepparent responsibility because it is both a law of general applicability, only remotely linked to ERISA, and within a traditional area of state regulation, child support, the court concluded. In addition, the court said there is considerable evidence that Congress did not intend for ERISA to preempt state child support statutes.
The case was brought by the Commissioner of Essex County Department of Social Services to require Wal-Mart Stores, Inc. Associates’ Health and Welfare Plan to extend health insurance benefits to the stepson of Wal-Mart Employee Amie Vradenburg pursuant to a QMCSO. Wal-Mart refused to enroll Vradenburg’s stepson, saying he does not meet the plan’s eligibility guidelines for a dependent child and the order cannot override those guidelines.
Vradenburg admitted that she has never lived with her stepson; is not his legal guardian; and has never claimed him as a dependant for tax purposes.
The case is O’Neil v. Wal-Mart Corporation, Case No. 8:05-cv-01572-LEK-RFT, N.D.N.Y., filed 8/22/07.
