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Medical Support

Medical support is a form of child support owed by a non-custodial parent as stated in an order for support issued by Family Court. "It requires one or both parents to provide health insurance and requires both parents to pay a portion of medical expenses not covered by health insurance for their children."

Legal paternity/parentage must first be established before an unmarried or a civil marriage/union parent can be held responsible for medical support.

Legal Requirements and Statutes: Recent amendments to the Social Security Act have had an impact on medical support and the employer's responsibility. For example, the law now requires employers to honor medical support orders established under State law.

The court or administrative agency may require that an employee provide medical insurance coverage for his/her dependents. The court will require coverage if it is available to the employee at a reasonable cost, defined as coverage available through the employer or other group health insurance (e.g. union).

Enrollment: The employer will receive an order from the court or administrative agency and will be required to enroll the dependents in the ordered insurance plan and withhold premiums from the employee's income or wages. This order may be subsequent to, or in conjunction with, an order to withhold a monetary child support obligation.

The dependent(s) must be enrolled in family coverage without regard to seasonal restrictions (e.g. Open Enrollment).

The dependent(s) cannot be denied coverage on the grounds that the parents were not married nor in a civil marriage/union, that the dependent is not claimed as a dependent on the employee's Federal income tax return, or that the dependent does not reside with the employee, or in the insurer's service area.

Cancellation of Enrollment: The employee cannot eliminate coverage of the dependent - unless the employee provides written proof that the order is no longer in effect, or that the dependent will be enrolled in comparable health insurance coverage elsewhere. The employer cannot eliminate coverage unless the employer has eliminated it for all employees.

Payroll Deduction: In all orders for health insurance, the court shall include provisions directing the employer to enroll and deduct an amount sufficient to provide for premiums for health care coverage offered by the employer. Income withholding for child and medical support has priority over all other legal processes against income, except for Federal liens (for example IRS liens that are in place when the order is served upon the employer).

Income withholding for medical support (and/or child support monetary award) cannot exceed the maximum amount under the Consumer Credit Protection Act (CCPA).

Insurer's Responsibility: Over the last ten years, legislation has been passed requiring insurers to cover dependents with medical support orders. These reforms in the health insurance industry mandate that health insurance companies, rather than employers, have the following responsibilities: The health insurance plan may not discriminate against the dependent if the dependent receives Medicaid, is adopted by the non-custodial parent, or has a pre-existing condition. The health insurance company must provide necessary information to the custodial parent so that claims can be directly submitted for covered services without the approval of the employee, and must reimburse the custodial parent, the providers, or State agency directly for claims submitted. As a result of these insurance industry reforms, the health insurance companies are aware that these are their responsibilities.