Creating a Medical Child Support Order

A medical child support order must be submitted and qualified to become a Qualified Medical Child Support Order (QMCSO).

What You Need to Do

  1. Get the employer's procedures (requirements) and model language form. Email us for the employer's QMCSO requirements and model language. We'll respond to you in 2 business days.

    Model Language

    Sample language, preapproved by the employer, that parties may choose to use when drafting an order.

    Include the following information:

    • Your name
    • Employer's name (include in the subject line and body of the email)
    • Employee's name
    • Plan name
    • Last 4 digits of the employee's Social Security Number

    alert For your own security, don't include personal and confidential information (such as a full Social Security Number or your order) in the email, except for the information we've requested.

  2. Create the medical child support order. There are 2 ways you can create the order:
    • Use the employer's model language form--The model language form you receive from the Qualified Order Center in Step 1 has been preapproved by the employer. If you complete it accurately, it will satisfy the employer's QMCSO requirements.
    • Create your own order--Be aware there are many ways to draft the terms of a QMCSO. When drafting your own order, you may want to consult with any attorney to best handle your case. You may also want to view the employer's model language form for the common structure.

    Note: The order must be completed accurately and satisfy all the general QMCSO requirements and the employer's QMCSO requirements.

  3. Review the completed order carefully before sending it. Here are the top reasons why a medical child support order is denied QMCSO status:
    • It's missing the employee's or child(ren)'s name.
    • Plan Name

      There are several reasons an order may be denied due to the plan name, and the following example is just one of those reasons. John Sample is in the XYZ Company Hourly Employees' Medical Plan, but the order lists the XYZ Company Salaried Medical Plan.

    • It's missing the employee's or child(ren)'s address.
    • It's missing the employer's name.
    • Benefit Assignment

      There are several reasons an order may be denied due to benefit assignment, and the following example is just one of those reasons. The employer can't accept a valuation date in a medical child support order before 01-01-2007, but the order uses a valuation date of

    • It's missing a judge's signature and court certification.
    • Court Certification Requirements

      There are several reasons an order may be denied due to court certification requirements, and the following example s just one of those reasons. The order has been signed by a judge and contains a filed stamp, but it doesn't include a required court certification stamp or seal from the clerk of the court.

  4. Send your order.
    1. Get the completed order signed by a judge.
    2. Have the order court-certified by the clerk of the court.


      A court-certified order is signed or stamped by the judge or other court official and has a stamp or seal from the clerk of the court stating the order is certified. Contact us to learn if a photocopy or a faxed copy of a court-certified order is acceptable for qualification requirements.

    3. Mail the form to:
      Qualified Order Center
      Post Office Box 1433
      Lincolnshire, IL 60069-1433
  5. Wait 15 business days to receive a written response about the determination of the order.

What the Qualified Order Center Will Do

Once the order is received, the Qualified Order Center will:

  • Review the order.
  • Notify all parties in 15 business days of receiving the order whether it meets all qualification requirements.
  • Send the following, as appropriate, to all parties named in the order and their designated representatives:
    • Copy of the QMCSO procedures
    • Determination letter
    • Copy of the order
    • Model language
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Did You Know?

It takes 15 business days from the time a medical child support order is received for the Qualified Order Center to review it.

You'll receive written notification by postal mail after the 15-business-day review is completed.