Jackson Law Group
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A Medical Support Order must be provided for in all suits affecting the parent-child relationship (including divorces) and in proceedings under the Uniform Interstate Family Support Act.  In determining the manner in which health insurance is to be provided, the court must consider the cost and quality of health insurance coverage available to the parties, giving priority to health insurance coverage available through the employment of one of the parties

The term health insurance means insurance coverage that provides basic health care services, including usual physician services, office visits, hospitalization, and laboratory, X-ray, and emergency services, that may be provided through a health maintenance organization (HMO) or other private or public organization.

If health insurance is available for the child through the obligor’s employment or membership in a union, trade association, or other organization, the court must order the obligor to include the child in the obligor’s health insurance unless either party shows good cause why such an order would not be in the best interest of the child. This rule, read in conjunction with Family Code Section 154.182(a), which requires a judge to consider the costs and benefits and to give priority to employer plans, has been interpreted to mean that a judge may, but is not required to, order insurance through the obligor’s employer. That is, Section 154.182 does not create a rebuttable presumption requiring the judge to accept the obligor’s offer of insurance when other alternatives are available. On the other hand, a trial court must accept an obligor’s offer of employer coverage if rejecting that offer would leave the child totally uninsured.

If health insurance is not available through the obligor’s employment but is available for the child through the obligee’s employment or membership in a union, trade association, or other organization, the court may order the obligee to provide health insurance for the child and, in that event, must order the obligor to pay to the obligee an additional amount of child support to be withheld from disposable earnings for the actual cost of the health insurance for the child, unless either party shows good cause why such an order would not be in the best interest of the child.

If health insurance is not available for the child through either the obligor’s or obligee’s employment, the court must order the obligor to provide health insurance for the child if the court finds that health insurance is available for the child from another source and the obligor is financially able to provide it, unless either party shows good cause why such an order would not be in the best interest of the child.

Health Insurance coverage is a child support obligation. Any amount that an obligor is required to pay for health insurance for the child is a child support obligation in addition to the amount that the obligor is required to pay for child support under the guidelines, and may be enforced as a child support obligation. Although under Family Code Section 154.183(a) insurance costs are to be paid in addition to child support and are a separate obligation, the cost of the insurance may be subtracted from the obligor’s gross income to determine the amount of support due.

Such an order pertaining to health insurance must require the obligor to provide to the obligee, local domestic relations office, or the Title IV-D agency, as specified in the order, the following information not later than the 30th day after the date the notice of the rendition of the order is received: (1) the Social Security number of the obligor; (2) the name and address of the obligor’s employer; (3) whether the employer is self-insured or has health insurance available; (4) proof that health insurance has been provided for the child; and (5) the name of the health insurance carrier, the number of the policy, a copy of the policy and schedule of benefits, a health insurance membership card, claim forms, and any other information necessary to submit a claim or, if the employer is self-insured, a copy of the schedule of benefits, a membership card, claim forms, and any other information necessary to submit a claim. In addition, the parent providing health insurance must furnish the obligor, obligee, local domestic relations office, or Title IV-D agency, as specified in the order, with any additional information regarding health insurance coverage that becomes available to the parent. The information must be provided not later than the 15th day after the date the information is received

An order or notice to an employer directing that health insurance coverage be provided to a child of an employee or member is binding on the current or subsequent employer on receipt without regard to the date the order was rendered. If the employee or member is eligible for dependent health coverage for the child, the employer must immediately enroll the child in a health insurance plan regardless of whether the employee is enrolled in the plan. If dependent coverage is not available to the employee or member through the employer’s health insurance plan, or the enrollment cannot be made permanent, or the employer is not responsible or otherwise liable for providing such coverage, the employer must notify the sender. If additional premiums are incurred as a result of adding the child to the health insurance plan, the employer must deduct the health insurance premium from the employee’s earnings in accordance with the provisions regarding income withholding, and must apply the amount withheld to payment of the insurance premium.

An employer who has received an order or notice pertaining to health insurance coverage must provide to the obligee, obligor, local domestic relations office, or Title IV-D agency, by first class mail not later than the 30th day after the date the employer receives the order or notice, a statement that the child either (1) has been enrolled in a health insurance plan; or (2) cannot be enrolled or cannot be permanently enrolled in a health insurance plan and provide the reason why coverage or permanent coverage cannot be provided.

If the obligor ceases to be employed by the employer, or if the health insurance coverage lapses, the employer must provide notice of the termination or lapse and of the availability of any conversion privileges to the obligor, obligee, local domestic relations office, or Title IV-D agency, as specified in the order, by first class mail not later than the 15th day after the date of the termination of the employment relationship or the lapse of the health insurance policy.

A parent who fails to provide health insurance as ordered is liable for any necessary medical expenses of the child, without regard to whether the expenses would have been paid by health insurance had it been provided.

An employer who fails to enroll a child, fails to withhold or remit premiums or cash medical support, or discriminates in hiring or employment on the basis of a medical support order is subject to penalties and fines.

If the health insurance coverage for the child lapses or terminates, the obligor must notify the obligee and any child support agency enforcing a support obligation against the obligor not later than the 15th day after the date of the termination or lapse. If additional health insurance is available or becomes available to the obligor for the child, the obligor must notify the obligee and the child support agency not later than the 15th day after the date the insurance becomes available. If termination of coverage results from a change of employers, the obligor, the obligee, or the child support agency may send the new employer a copy of the medical support order or notice of the order. The obligor must enroll the child in a health insurance plan at the next available enrollment period.

The Family Code provisions regarding medical support orders do not limit the rights of the obligor, obligee, local domestic relations office, or Title IV-D agency to file suit to enforce, modify, or clarify the child support or health insurance order. Nor do they limit the authority of the court to enter or modify child support or health insurance orders containing provisions for payment of uninsured health expenses, health care costs, or health insurance premiums that are in addition to and inconsistent with the Family Code provisions regarding medical support orders.

On request, the employer must release to the obligee, obligor, or a child support agency, information concerning the available health insurance coverage, including the name of the health insurance carrier, the policy number, a copy of the policy and schedule of benefits, a health insurance membership card, and claim forms.

Receipt of a medical support order requiring that health insurance be provided for a child must be considered a change in the family circumstances of the employee or member, for health insurance purposes, equivalent to the birth or adoption of a child. If the employee or member is eligible for dependent health coverage, the employer must automatically enroll the child for the first 31 days after the employer receives the order or notice of the order on the same terms and conditions as apply to any other dependent child. The employer must notify the insurer of the automatic enrollment. During the 31-day period, the employer and insurer must complete all necessary forms and procedures to make the enrollment permanent, or must report the reasons the coverage cannot be made permanent.

If a plan administrator determines that a medical support order does not qualify for enforcement under federal law, the court may, on its own motion or the motion of a party, render an order that does qualify.