Establish Medical Support
At every support conference, conference officers will attempt to establish medical insurance coverage in all child support cases. The goal is to have every child covered. If available through a party’s employer, either at no cost or at reasonable cost to the employee, that coverage would be ordered. Reasonable cost is defined by federal regulation as an amount not to exceed 5% of a party’s net earnings.
A party’s (not an employer’s) cost for insurance coverage, whether paid by the payer or payee, is shared by both parties in proportion to their net incomes, after subtracting out the share of the cost for any parties not subject to the order. That adjusted cost is added to or subtracted from the obligation as appropriate. If employer-based insurance is not available, coverage is available through Medicaid or CHIP, depending on family income.
Within thirty days of being ordered to provide medical insurance coverage, the party so ordered must submit to the other party and to the Domestic Relations Section written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall, at a minimum, consist of:
- Name of the health care provider
- Any applicable identification numbers
- Any cards evidencing coverage
- Address to which claims should be made
- Description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval
- Copy of the benefit booklet or coverage contract
- Description of all deductibles and co-payments
- Five copies of any claim forms
The monthly support obligation includes cash medical support in the amount of $250 annually for unreimbursed medical expenses incurred for each child and/or spouse. Unreimbursed, out of pocket expenses (co-pays, deductibles, and all expenses incurred for reasonably necessary medical services, including but not limited to surgical, dental, optical services, prescriptions, and orthodontia), in excess of $250 per person per year, may be allocated proportionally between the parties.
Cosmetic, chiropractic, psychiatric or psychological services, unless specifically directed by the order, and over-the-counter products are not included. Ongoing, predictable expenses can be built into the order as a specific, recurring amount, otherwise the obligation will be stated as a proportional share of any expenses which might occur. An unreimbursed medical expense form with instructions for tracking and submitting the expense to the other party is available as a download here.
Children's Health Insurance Program (CHIP)
CHIP is the state’s nationally-recognized program that provides free, or low-cost, health insurance to children under 19 whose families earn too much money to qualify for Medicaid, but not enough to purchase private health insurance.
Children enrolled in CHIP are eligible for numerous benefits, including prescription drugs; routine checkups; immunizations; diagnostic testing; emergency care; dental, vision and hearing services; mental-health benefits; inpatient hospitalization up to 90 days per year; durable medical equipment, such as wheelchairs and walkers; rehabilitation therapy (speech, occupational, physical and respiratory); drug- and alcohol-abuse treatment; hearing aids; home health care, such as nursing services and post-operative care; and partial hospitalization for mental-health services.
Families are encouraged to log onto the CHIP website or call the toll-free helpline at (800) 986-KIDS to get more information about benefits and to find out if their children qualify for free, or low-cost, health insurance. All calls and inquiries are confidential.
Applications are screened and individuals may be enrolled in either CHIP or Medicaid Program if they meet certain eligibility criteria. If appropriate, CHIP applications are forwarded to the local County Assistance Office for processing.
The AdultBasic program provides low-cost health insurance for uninsured adults between the ages of 19 and 64. The insurance contractors and coverage areas are noted on Attachment 3. Although funding for AdultBasic is limited and applicants may be placed on a waiting list, individuals are still encouraged to apply. Applicants are screened for potential eligibility for Medicaid, which provides more extensive benefits. An application for AdultBasic may be obtained by calling (800) GO-BASIC (462-2742) or an application may be made online.