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Healthcare Options, Medical Expenses, and Child Support

When it comes to ensuring the well-being of your children, health and dental insurance are essential aspects of their care. If you’re currently paying child support, you might wonder how to handle health and dental insurance for your children. In this article, we will explore the options available to you and provide insights on making the best decisions for your family’s healthcare needs.

Two Options for Health and Dental Insurance

If you’re obligated to provide health and dental insurance for your children due to child support arrangements, you have two primary options:

Enroll the Children in Your Insurance

You can choose to enroll your children in your own health and dental insurance plan. In this case, you will be responsible for paying the insurance premiums, typically deducted from your paycheck. If you’re self-employed or don’t have access to employer-sponsored insurance, you can purchase a policy to cover your children.  

The Other Parent Enrolls Your Children

If health and dental insurance are available to the other parent through his/her employment, then the other parent can enroll your children in their health and dental insurance plan. In this scenario, you would most likely be required to reimburse the other parent for the actual cost of your children’s insurance coverage.  This obligation to reimburse the other parent will be treated as a child support obligation, and can be paid through an Income Withholding Order (just like monthly child support).  

Factors to Consider

If both you and the other parent have stable employment with good benefits, deciding on the best option for your children’s insurance coverage can be a complex task. Here are some factors to consider:

Actual Cost of the Premium: 

Look at the costs specifically for your children. Your employer typically provides a chart that outlines the costs for different coverage options, such as Employee, Employee + Spouse, Employee + Spouse + Children, and Employee + Children. To determine the cost for your children, subtract the cost of Employee-only coverage from the Employee + Children coverage. If you have multiple children to cover, including children from another relationship, then you may breakdown that cost per child such that the obligor is paying only for his/her children.

Comparing Plans: 

Lower premiums might lead to higher out-of-pocket costs. Examine the deductible, whether it’s a family deductible or individual deductible.  Note that the parent enrolling the children in a “family plan” may have the benefit of the children’s expenses going towards his/her family deductible.

Network Providers:

Ensure that the healthcare providers your children use are in-network for the chosen insurance policies.  The standard provisions regarding sharing unreimbursed medical expenses typically applies only to in-network providers – so if there are providers your family uses who are outside of the network, you may want to include a provision regarding agreement to continue using those out of network providers.

Job Stability: 

Consider your and the other parent’s job stability. Changing jobs can impact deductibles and coverage.  For example, if you end up changing jobs in the middle of the year, you will likely reset the deductible for your new employer.  Of course, many job changes are not known at the beginning of the year.  Just be aware that if you are thinking about changing jobs, you may want to discuss the benefits of covering your children through the other parent’s employment.

Adjustment Clause: 

If the parent enrolling the children in health insurance is not the obligor for health insurance, ensure that your orders have a clause allowing adjustments for changing premium costs.

Remember that child support, including medical support, is a court-ordered provision and can’t be altered by a written agreement between the parties. You need to modify the court order itself if changes are needed.

If you have specific questions about your unique situation and would like to consult with an attorney regarding providing health insurance for your children, feel free to contact a legal professional.

Unreimbursed Medical Expenses

Aside from health insurance premiums, you may encounter additional costs related to your child’s healthcare. These can include copays, prescriptions, and out-of-network therapy fees. These unreimbursed medical expenses can quickly add up, and getting the other parent to share the costs can sometimes be challenging.

In Texas, orders regarding unreimbursed medical expenses can be quite extensive, and specific steps must be followed to establish a claim for reimbursement. Here’s what you need to do:

Percentage of Unreimbursed Medical Expenses: 

Check the percentage specified in your orders. In most cases, these expenses are split 50/50, but it’s essential to review your specific provisions.

Document the Expenses: 

Keep records of the services provided and the provider’s details, along with the receipts showing the amounts you’ve paid. If you’re on a payment plan, your reimbursement will be a fraction of the total expense.

Explanation of Benefits (EOB): 

If you’re providing health insurance, you must supply the EOB to the other parent, which usually arrives by mail within about 30 days of the service.

Provide Notice: 

Notify the other parent of the expenses incurred and submit the invoice, receipt, and EOB if applicable. If the other parent is the one providing health insurance, ask them for a copy of the EOB to confirm what’s covered.

Track Expenses: 

Maintain a spreadsheet that includes the cost of service for your child, the provider’s name, the date of service, and the date notice was given to the other parent.

Check out our Medical Expenses Tracking spreadsheet.

In most cases, when notice is provided to the other parent within 30 days of the expense, they have 30 days to reimburse. Some orders may allow up to 120 days if notice is provided later. Staying on top of expenses and providing timely notice is advisable.

If the other parent fails to pay the amount due on time, they may face an enforcement proceeding. This proceeding typically involves an initial hearing to confirm the amount owed, with a set deadline for payment. Additional costs like attorney’s fees, penalties, and interest can be added to the principal amount, making it a costly mistake not to pay unreimbursed medical expenses.

However, it’s crucial to ensure that you’re working with in-network providers and following the rules outlined in your court order. If you seek services from an out-of-network provider, such as an orthodontist or therapist, make sure to obtain written agreement from the other parent or risk being responsible for the bill.

Sharing the costs of unreimbursed medical expenses is a vital part of child support. While the guidelines may seem complex, consulting with an attorney to understand your specific court order and ensure you’re on the right track for collecting the other parent’s share of unreimbursed medical expenses is a wise step.

If you have further questions or need legal guidance regarding your child’s medical expenses, don’t hesitate to contact a qualified attorney for assistance.