Health Insurance for Children

General Provisions

In addition to guideline child support, each parent is required to maintain health insurance for minor children if it is available at no cost or reasonable cost. This includes vision and dental coverage. If such coverage is not presently available, the parent will be ordered to put the children on a plan when it becomes available to that parent. This also applies to adult disabled children who are not capable of supporting themselves. The court must also provide for the payment of the children's medical expenses that are not covered by available health insurance.

Where the parent has a group health insurance plan available, it is presumed that such a plan comes within the definition of "reasonable in cost." This means that the parent is required to maintain that coverage unless the court finds that the actual cost is too much for the parent to afford.

Notice of Available Health Insurance

If a parent has health insurance that is available for supported children, he/she is required to inform the local child support collection agency. In addition, all child support court orders are required to provide that the parents are to keep each other informed of the availability of health insurance for their children.

Where Each Parent Has a Plan

If both parents have health insurance coverage, the plan of the custodial parent will usually be considered the primary plan. However, a court order can designate which parent's plan will be the primary plan. The decision about which plan will be the primary plan is usually determined by comparing the terms of coverage and the costs of each plan.

County Support Actions

Where the county has initiated child support collection against a parent, it can also request that the court order the parent to maintain health insurance coverage. The child support agency can also request that a parent's employer and health insurance carrier inform the agency if there has been an interruption of coverage.

Health Insurance Coverage Assignment

Where requested by a parent or the local child support collection agency, the court is required to issue a "health insurance coverage assignment," under which a parent's employer or can be directly ordered to provide coverage for a supported child.

A request for a health insurance coverage assignment is made by filing an Application and Order for Health Insurance (Calif. Judicial Council Form No. FL-470). This form can be obtained on line at www.courtinfo.ca.gov/forms. The parent requesting the assignment is required to give the other parent at least 15 days advance notice, by first-class mail, that the request is being filed.

A health insurance coverage assignment is usually mandatory. However, the support-paying parent can object to the issuance of the assignment if that parent can show that he/she would suffer an "extraordinary hardship' if the assignment is issued.

After the health insurance coverage assignment is issued it must be served on the parent's employer. This can be done by first-class mail. The insurance coverage must then be established by the employer within 20 days after the assignment order is served. The health insurance coverage assignment applies to all future plans that are available to the parent from subsequent employers.

Limitations on Denial of Coverage

An employer or health care plan cannot deny coverage to a child on any of the following grounds:

● The child was born out of wedlock

● The child is not claimed as a dependent on the participating parent's federal income tax return.

● The child does not reside with the participating parent or within the insurer's service area.

The Family Code requires that health care plans to enroll supported children, regardless of any enrollment period restrictions. In addition, if the covered parent fails to enroll the child, the other parent or the child support agency can enroll the child by presenting the plan with a copy of the court order.

Benefit Administration Requirements

Once the employer or the plan is presented with a copy of the court order, it must provide the uncovered parent with an identification cards, as well as the same on-going information about the plan that are given to the covered parent. In addition, the noncovered parent must be permitted to submit claims on behalf of the covered child and the plan is required to make claims payments directly to that parent. Any employer or plan that fails to cover a child under a valid assignment order is liable to the applicant for the amount incurred in health care services that would otherwise have been covered under the insurance policy but for the conduct that was contrary to the assignment order.

Termination of Coverage
A plan is required to notify the parents of any termination of the coverage. However, such notification is required only if the plan has been provided with a copy of the court order that provides for the coverage, the health insurance coverage assignment or a National Medical Support Notice from a child support collection public agency.

Under certain specified circumstances, a support-paying parent can ask the court for an order terminating the health insurance coverage assignment. These circumstances include the discontinuance of the coverage or the emancipation of the covered child.

Reimbursement of Health Care Costs

The Family Code requires court orders to provide for the reimbursement by a parent who has advance health care expenses for a covered child. In order to obtain reimbursement, the parent incurring the expense must first provide the other parent with an itemized statement of the costs within 30 days after the costs were paid. The other parent must make the requested reimbursement within the next 30 days. Where the parent incurring the cost paid only his/her share to the provider, the other parent must remit his/her share to the provider within that 30 day period.

Qualified Medical Child Support Orders

Federal law provides for the creation of a "Qualified Medical Child Support Order," otherwise known as a "QMSCO." Under this law, all group health insurance plans are required to provide benefits that are in compliance with any qualified medical child support order that is issued by a family law court.

In order to be deemed "qualified" a family law child support order must include the following:

● The name and last known mailing address of the plan participant.

● The name and last known mailing address of the covered child.

● A "reasonable description" of the health insurance coverage that is to be provided.

● The period of time during which the order will be in effect.

● A description of each plan which is covered by the order.

An order will not be considered qualified if it provides for coverage that is not available under the plan.