We like to think all parents want to support their children financially and ensure they are well taken care of. And when parents are together either as spouses or partners, spending money on a child doesn’t seem to be a big deal.
But as soon as parents separate, and the dreaded word child support is mentioned, things can become contentious fast.
Fortunately, the law is pretty clear on how child support is calculated and most of the time the matter is resolved fairly easily. Both parties may not be happy but the child support obligation will be in place.
One component of child support is health insurance.
And as we all know, health insurance is not cheap. Health insurance premiums are included in the child support calculation. The obligation to provide health insurance is either included in an agreement or court order.
If either parent has the ability to provide health insurance through his or her employment at a reasonable cost, the court will most likely order one party to enroll the child.
If the parent required to provide health insurance is not the primary custodian of the child, then the court can put measures in place to ensure coverage for the child.
How can a parent be required to provide health insurance?
A Medical Child Support Order is issued by the court requiring the parent to either provide monetary support for health insurance or coverage under his or her employee health care plan for the child or children.
In 1993 there was an amendment to the Employee Retirement Income Security Act (ERISA) that required employment-based group health plans to extend health care coverage to the children of a parent-employee who is divorced, separated, or never married when ordered to do so by state authorities.
What is a Qualified Medical Child Support Order?
A Qualified Medical Child Support Order (QMCSO) is a little different in that it specifically sets forth the right of dependents (children)to receive benefits under group health plans.
A qualified medical child support order allows a non-employee, custodial parent (the parent who has the child or children the majority of the time) to obtain health insurance under the plan the non-custodial parent has with his or her employment.
It requires a health plan to include a child as covered under a health plan, even if the children or the participant do not meet the conditions of the health plan.
For example, if the participant has not been employed as long as normally required to be covered by the plan, the administrator of the plan would have procedures in place to ensure the child starts receiving benefits as soon as the employee/participant has met the waiting period.
A QMCSO is normally obtained by a divorced or separated spouse or by a state child support or Medicaid agency.
The order authorizes withholding the participant’s/non-custodial parent’s share of the cost for coverage from their pay. They may not drop coverage for the child without proof that the QMCSO is no longer in effect.
Another benefit of QMCSO is that it may require a plan to enroll a child before the plan’s next enrollment period.
How Do You Ensure the Order is “Qualified?”
For a medical child support order to be qualified it must contain the following information:
- The name and last known mailing address of the participant and each alternate recipient. The order may substitute the name and mailing address of a State or local official for the mailing address of any alternate recipient;
- A reasonable description of the type of health coverage to be provided to each alternate recipient (the child/children) (or the manner in which such coverage is to be determined) ; and
- The period to which the order applies.
- The order may not require a plan to provide any type or form of benefit, or any option, not otherwise provided under the plan, except to the extent necessary to meet the requirements of certain State laws.
The plan needs the order to be qualified so the administrator of the plan will have enough information about the children and the participant-parent to enroll and implement the benefits.
This is truly just a matter of providing correct, basic information in the order so that the enrollment in the plan will be an easy process.
Who Determines if the QMCSO is Qualified?
The administrator of the group health plan determines whether the order is qualified.
The administrator is required to make this determination within a reasonable period of time pursuant to reasonable written procedures that have been adopted by the plan.
The administrator must first notify the participant/employee and the alternate recipient/child when the plan receives a medical child support order and must give them copies of the plan’s procedures for determining whether it is qualified.
The administrator must notify the parties of its decision of whether or not the order is qualified.
If the order misstates an address or birthday, and the plan administrator can easily find said information, they will usually correct the mistake without sending the order back to be modified.
However, it is important that the correct information is provided so the administrator can seamlessly implement the health insurance plan for the benefit of your child.
What if the group health insurance plan of you Ex does not provide dependent (child) coverage?
If the group health insurance plan does not offer dependent/child coverage as an option then a medical support order could not require it to do so.
The medical child support order cannot require a plan to provide a benefit or option for coverage that is not otherwise available under the plan.
What happens if the employer cannot withhold the health insurance premium payments from the employees check?
Typically, health insurance premiums are paid by the employer withholding the amount of the premium from the employee’s check.
However, there are Federal and State limitations on exactly how much can be withheld from an employee’s paycheck in the context of child support payments.
For example, an employer cannot withhold 60% of an employees check for child support and health insurance premiums.
If the additional premium amount for health insurance that would be withheld exceeds the amount an employer can withhold from a check, then the employer should notify the custodial parent, and the child support enforcement agency if one is involved.
If the employer cannot withhold the necessary contribution from the participant’s paycheck, the plan is not required to extend coverage to the child.
Other options would be the custodial parent or agency could modify the amount of cash support provided to the custodial parent so that the employer could withhold the required contribution to the plan.
Or the employee/participant may voluntarily consent to the withholding of an amount otherwise in excess of applicable withholding limitations.
How could my child lose coverage?
If the plan terminates coverage when a participant/employee ends employment, and neither the participant/employee nor the alternate recipient/child elect COBRA continuation coverage, the plan may stop coverage for the alternate recipient/child.
Also, if the plan ceases to provide coverage for dependents who are over the age of 18, the coverage of an alternate recipient/child who is over the age of 18 may be terminated unless continuation coverage is elected.
In cases where the employee, your ex spouse, has been fired or terminated his employment intentionally you would certainly want to go back to court as quickly as possible to require him or her to acquire new coverage or COBRA unless they will agree to provide seem.
Even if the termination of employment was not voluntary, it still may be necessarily to go back to court if the parent/employee will not assist you in acquiring COBRA for the child or provide alternate health insurance.
The bottom line is the courts are always concerned with the well being of children, and health insurance is a vital component of caring for children.
The QMCSO is an effective vehicle to ensure your child can obtain health insurance coverage from the other parent’s group health insurance plan.