medical coverage problem

[challenges]

What is the name of your state (only U.S. law)? CA and IL
Hi, I am the mom and CP of two children. The NCP lives in CA and the children and I moved to IL 6 years ago. Everything has been relatively fine with child support until now. The NCP's employer no longer offers health insurance that covers out-of-State care (as has been the case for the past 6 years). So he enrolled them in a CA plan.

This is the wording in the court order [it's a form and the box next to "respondent" (NCP) is checked]: "Health insurance coverage for the minor children of the parties must be maintained by the respondent/defendant if available at no or reasonable cost through their respective places employment or self-employment. Both parties are ordered to cooperate in the presentation, collection, and reimbursement of any health-care claims."

Does this mean we need to go back to court if we can't resolve this? He's saying that he has them covered but they can only be seen by doctors in CA unless it's an emergency. The children (one with medical issues) live in IL 75% of the time.

The NCP is not willing to work with me on finding IL insurance and I don't know how to interpret that Order under these conditions. Any advice? Thanks!

 

[sandyclaus]

What is the name of your state (only U.S. law)? CA and IL
Hi, I am the mom and CP of two children. The NCP lives in CA and the children and I moved to IL 6 years ago. Everything has been relatively fine with child support until now. The NCP's employer no longer offers health insurance that covers out-of-State care (as has been the case for the past 6 years). So he enrolled them in a CA plan.

This is the wording in the court order [it's a form and the box next to "respondent" (NCP) is checked]: "Health insurance coverage for the minor children of the parties must be maintained by the respondent/defendant if available at no or reasonable cost through their respective places employment or self-employment. Both parties are ordered to cooperate in the presentation, collection, and reimbursement of any health-care claims."

Does this mean we need to go back to court if we can't resolve this? He's saying that he has them covered but they can only be seen by doctors in CA unless it's an emergency. The children (one with medical issues) live in IL 75% of the time.

The NCP is not willing to work with me on finding IL insurance and I don't know how to interpret that Order under these conditions. Any advice? Thanks!

Well, obviously you aren't going to haul the children off to California every time they need to see a doctor. God forbid there is an emergency and they require immediate hospital care.

Sounds to me like you will need to go back to court to address the issue. If NCP is positive that his employer no longer offers any insurance options that provide out of state coverage, then you may end up having to provide the insurance, and maybe NCP will have to pay for it, or something will need to be worked out in order to obtain private insurance that will cover the children in IL.

 

[mistoffolees]

What is the name of your state (only U.S. law)? CA and IL
Hi, I am the mom and CP of two children. The NCP lives in CA and the children and I moved to IL 6 years ago. Everything has been relatively fine with child support until now. The NCP's employer no longer offers health insurance that covers out-of-State care (as has been the case for the past 6 years). So he enrolled them in a CA plan.

This is the wording in the court order [it's a form and the box next to "respondent" (NCP) is checked]: "Health insurance coverage for the minor children of the parties must be maintained by the respondent/defendant if available at no or reasonable cost through their respective places employment or self-employment. Both parties are ordered to cooperate in the presentation, collection, and reimbursement of any health-care claims."

Does this mean we need to go back to court if we can't resolve this? He's saying that he has them covered but they can only be seen by doctors in CA unless it's an emergency. The children (one with medical issues) live in IL 75% of the time.

The NCP is not willing to work with me on finding IL insurance and I don't know how to interpret that Order under these conditions. Any advice? Thanks!

Sounds like ex is following the court order. The order says that NCP has to provide insurance if it's available through employment. S/he has the kids on the only policy available to him/her. I don't see any contempt.

You could ask the court for a new order, but you'll need a change of circumstances to get the order changed. I don't know if a change of insurance would count. Clearly, the wording suggests that the court recognized that NCP might not always be able to provide insurance, so it doesn't sound like a CoC to me, but I'll defer to the CA people.

 

[challenges]

Thank you for your responses. I have insurance through my school but open enrollment is in August so I can't get the kids covered that way. There is a program in IL for people who can't afford ins (me) but they won't take the kids because they already have coverage through their Dad. I'm really stressed about this because insurance runs out 12/31.

 

[Nevergrowup]

What does it state about unreimbursed medical expenses? Is there a split outlined? Dad may be creating a huge expense for himself too if he has to be a portion of unreimbursed expenses, which would be basically everything except emergencies.

If the order says anything about that, I'd outline that part of the order and send it to your ex, with maybe an outline about how much typical care for your high medical needs child is going to potentially cost. Then propose that you, together, find a plan that covers more where you live, and offer to potentially share in the cost. It would benefit both of you to compromise.

 

[mistoffolees]

Thank you for your responses. I have insurance through my school but open enrollment is in August so I can't get the kids covered that way. There is a program in IL for people who can't afford ins (me) but they won't take the kids because they already have coverage through their Dad. I'm really stressed about this because insurance runs out 12/31.

Explain to them that they will no longer have coverage through their Dad in your state after 12/31.

Also, talk to your employer's benefits person. There are sometimes exceptions to the open enrollment period - if the kids are losing coverage for your state, you may be able to get them covered.

It would also be helpful for you to review Dad's insurance coverage to see what they mean by 'emergency' coverage. That is, exactly what is covered when the kids are with you? Are they covered only if they go to an emergency room or are they covered for any non-routine doctor's visit (or somewhere in between). If the 'non-emergency' clause is interpreted liberally enough, you might be OK with just that coverage for a while. Just try to get all their routine stuff done before the existing coverage runs out.

 

[stealth2]

Was in the same situation. It was ruled that he was providing insurance as required. If I wanted something that required less hoop jumping, I could pay for it myself. Not unreasonable, IMO.

 

[cbg]

Loss of other coverage is a qualifying event to pick up dependents outside of the open enrollment period. However, there has to be written documentation that the coverage HAS ENDED, not that it will end.

If coverage ends on December 31, you will have 30 (possibly 31) days to add the kids to your policy as of January 1. You will need a letter from Dad's employer that states that coverage has ended; it will need to name the kids by name and spell out the date that coverage ends. Your employer will have other requirements too; we have an enrollment form that you need to complete and we'll want copies of the kids' birth certificates if we don't already have them on file.

Now, whether you'll be able to convince Dad to cancel the coverage in CA (or whether his employer will even allow him to do so at this point - the IRS places limits on when an employer can and cannot allow changes and some employers are stricter about it than others) or not is something I can't gauge. But IF he can or will do so, you should be able to add them to yours within 30 days.

 

[mistoffolees]

Loss of other coverage is a qualifying event to pick up dependents outside of the open enrollment period. However, there has to be written documentation that the coverage HAS ENDED, not that it will end.

If coverage ends on December 31, you will have 30 (possibly 31) days to add the kids to your policy as of January 1. You will need a letter from Dad's employer that states that coverage has ended; it will need to name the kids by name and spell out the date that coverage ends. Your employer will have other requirements too; we have an enrollment form that you need to complete and we'll want copies of the kids' birth certificates if we don't already have them on file.

Now, whether you'll be able to convince Dad to cancel the coverage in CA (or whether his employer will even allow him to do so at this point - the IRS places limits on when an employer can and cannot allow changes and some employers are stricter about it than others) or not is something I can't gauge. But IF he can or will do so, you should be able to add them to yours within 30 days.

I hadn't thought about having Dad cancel coverage. That might work.

What about the change in Dad's policy? After it happens and if it no longer provides non-emergency care outside of CA, do you think that might be a qualifying event to allow Mom to add the kids to her policy?

 

[cbg]

It's not impossible, but I'd have to spend more time than I currently have confirming it. I *think* that this would be one of the lesser-known QE's that the IRS permits (somewhere in the back of my mind there's something to that effect) but I'll have to do the research later. I don't really have time even to be on the board today, much less the other.

It would be much simpler if Dad would cancel coverage, but he may or may not be able to do that. If their open enrollment period is over, his employer may not permit additional changes. They are not required to and not all employers will. Note that by law, they CANNOT allow additional changes, beyond a QE, after the new plan year starts.

If Dad cannot or will not cancel the coverage, then Mom's only option will be to see if the drastic change in coverage terms is a QE. I *think* it is but hopefully by then I can be sure.

 

[Antigone*]

I hadn't thought about having Dad cancel coverage. That might work.

What about the change in Dad's policy? After it happens and if it no longer provides non-emergency care outside of CA, do you think that might be a qualifying event to allow Mom to add the kids to her policy?

If dad cancels coverage he'll be violating his court order.

My husband and his ex were in the same boat with the boys. Dad had coverage in Ca. Mom brought kids to Ca for check ups but dad did pay for out-of-pocket expenses for any ER visits in their home state.

This was as a result of mom moving out of state with the children. The OP seems to be in the same situation. I cannot see a judge forcing dad to pay for more coverage since mom moved.

 

[cbg]

You know more about that aspect than I do, Tigi. I won't debate that point.

I won't have a chance to look into the QE from Mom's end till the weekend, but I'll try to see if that option exists when I get time. Somewhere in the back of my head there's tickling something that the lack of out of state coverage from Dad's employer might be a QE for Mom's employer, but that's a rare one and I'll have to look at the specifics.

 

[Antigone*]

You know more about that aspect than I do, Tigi. I won't debate that point.

I won't have a chance to look into the QE from Mom's end till the weekend, but I'll try to see if that option exists when I get time. Somewhere in the back of my head there's tickling something that the lack of out of state coverage from Dad's employer might be a QE for Mom's employer, but that's a rare one and I'll have to look at the specifics.

You are definitely the HR expert here, my dear. My experience with this is purely personal.

 

[mistoffolees]

It's not impossible, but I'd have to spend more time than I currently have confirming it. I *think* that this would be one of the lesser-known QE's that the IRS permits (somewhere in the back of my mind there's something to that effect) but I'll have to do the research later. I don't really have time even to be on the board today, much less the other.

It would be much simpler if Dad would cancel coverage, but he may or may not be able to do that. If their open enrollment period is over, his employer may not permit additional changes. They are not required to and not all employers will. Note that by law, they CANNOT allow additional changes, beyond a QE, after the new plan year starts.

If Dad cannot or will not cancel the coverage, then Mom's only option will be to see if the drastic change in coverage terms is a QE. I *think* it is but hopefully by then I can be sure.

This would have additional advantages, as well. If they both have insurance coverage on the child, there will be some overlap and reduce their out of pocket cost (although maybe not enough to justify the extra premium if the employers only pay a small fraction).

 

[challenges]

What does it state about unreimbursed medical expenses? Is there a split outlined? Dad may be creating a huge expense for himself too if he has to be a portion of unreimbursed expenses, which would be basically everything except emergencies.

Yes, we split out of pocket 50/50. It will create a huge expense for both of us.