Medical Insurance Premium Reimbursement

[NC Parent]

What is the name of your state (only U.S. law)? AZ

Per Divorce decree I am required to cover my children on my medical insurance. My Ex Wife (Custodial Parent) began to cover them when I became unemployed and ceased coverage. The coverage she provides is part of her new husband's Family Plan because they have 2 other children together. I have offered to reimburse her for this coverage several times, but we disagree on the amount of reimbursement. I think I should reimburse her for the actual cost of her insurance premium per child. She thinks I should pay her the amount that the insurance would cost me if I covered them. Because her family coverage is for 6 people and mine would be for 3, her actual cost is obviously much less than my hypothetical amount.

Once I was able to provide insurance again I attempted to cover them myself to be compliant with the decree. She stated she did not want me to because she did not want to deal with 2 insurances. I know her out of pocket expense doesn't change either way, and I am not trying to get out of my responsibility, but if I am going to pay my own premium rate, I'd rather pay it to my insurance company that to her for a variety of reasons (not just spite, but admittedly I'm sure that plays some part, too.)

Does anyone have past experience with this? If we went to court would the judge likely agree with her math or mine? Thank you for your input.

 

[LdiJ]

What is the name of your state (only U.S. law)? AZ

Per Divorce decree I am required to cover my children on my medical insurance. My Ex Wife (Custodial Parent) began to cover them when I became unemployed and ceased coverage. The coverage she provides is part of her new husband's Family Plan because they have 2 other children together. I have offered to reimburse her for this coverage several times, but we disagree on the amount of reimbursement. I think I should reimburse her for the actual cost of her insurance premium per child. She thinks I should pay her the amount that the insurance would cost me if I covered them. Because her family coverage is for 6 people and mine would be for 3, her actual cost is obviously much less than my hypothetical amount.

Once I was able to provide insurance again I attempted to cover them myself to be compliant with the decree. She stated she did not want me to because she did not want to deal with 2 insurances. I know her out of pocket expense doesn't change either way, and I am not trying to get out of my responsibility, but if I am going to pay my own premium rate, I'd rather pay it to my insurance company that to her for a variety of reasons (not just spite, but admittedly I'm sure that plays some part, too.)

Does anyone have past experience with this? If we went to court would the judge likely agree with her math or mine? Thank you for your input.

The judge would NOT order you to pay her what your insurance would have cost. The most the judge would order you to pay is the family portion of her husband's insurance divided by the number of family members it covers. The judge however, might not order you to pay anything at all since technically your children are really free...since they have to pay for family coverage for their joint children anyway.

 

[NC Parent]

The judge would NOT order you to pay her what your insurance would have cost. The most the judge would order you to pay is the family portion of her husband's insurance divided by the number of family members it covers. The judge however, might not order you to pay anything at all since technically your children are really free...since they have to pay for family coverage for their joint children anyway.

Thank you for the input. That's what I was hoping to hear. I am not trying to be unreasonable, just fair. She has an appointment with an attorney to discuss this and I am hoping they give her this honest answer. I have documented several times via email offering to reimburse her and then offering to cover them again, so hoping that this will work in my favor if she does try to take me to court.

Open to hearing opposing arguments, too if anyone has experienced a different outcome.

 

[LdiJ]

Thank you for the input. That's what I was hoping to hear. I am not trying to be unreasonable, just fair. She has an appointment with an attorney to discuss this and I am hoping they give her this honest answer. I have documented several times via email offering to reimburse her and then offering to cover them again, so hoping that this will work in my favor if she does try to take me to court.

Open to hearing opposing arguments, too if anyone has experienced a different outcome.

Her attorney definitely will NOT tell her that you have to pay her what your insurance would have cost. That is just an absurd idea on her part.

 

[NC Parent]

Her attorney definitely will NOT tell her that you have to pay her what your insurance would have cost. That is just an absurd idea on her part.

Thank you for your time!

 

[cbg]

Just be aware:

I have been administrating employer-sponsored benefits since 1979. In all that time, I have yet to see a plan where the cost is determined by the number of dependents who are covered. There will be a two tier, a three tier or a four tier plan, as follows -

Two tier - On a two tier plan, if you are covering any dependents at all, you pay the same rate. Doesn't matter if it's just your spouse or a spouse and eight kids - on a two tier plan family coverage costs the same no matter what.

Three tier - on a three tier plan, an employee only would pay one rate, an employee with one dependent would pay a different rate and an employee with two or more dependents would pay a third rate, but an employee with two dependents and an employee with eight dependents would still pay the same rate.

On a four tier plan there is one rate for employee only, one for employee plus a spouse, one for employee plus a child or children (because of the possibility of multiple children, this is higher than the cost of an employee plus a spouse) and finally one for "full family" - employee, spouse and children.

In 37 years of direct contact I have never - NEVER seen or heard of a plan where the exact number of dependents determined the rate. If both of you have four tier plans then your family coverage would be employee plus children and hers would be full family, but that is the only instance when the number of dependents you are covering would affect the amount you pay. In other words, just because your family plan would have only three people on it and hers would have six doesn't mean that there's automatically going to be a huge discrepancy in the family rate.

And before someone, probably LdiJ, gets on here and tells me that THEY'VE seen plans where the employee pays nothing for him/herself and the employee pays only for the dependents, I will acknowledge that yes, some employers have been known to do it that way. They are, however, not the norm, and even when that does happen the dependent rate is rarely if ever per-person. Yes, I do know that for sure.

I'm not saying the other posters are wrong; I'm saying don't assume that the number of dependents covered is going to have a huge difference on the rate.

 

[LdiJ]

Just be aware:

I have been administrating employer-sponsored benefits since 1979. In all that time, I have yet to see a plan where the cost is determined by the number of dependents who are covered. There will be a two tier, a three tier or a four tier plan, as follows -

Two tier - On a two tier plan, if you are covering any dependents at all, you pay the same rate. Doesn't matter if it's just your spouse or a spouse and eight kids - on a two tier plan family coverage costs the same no matter what.

Three tier - on a three tier plan, an employee only would pay one rate, an employee with one dependent would pay a different rate and an employee with two or more dependents would pay a third rate, but an employee with two dependents and an employee with eight dependents would still pay the same rate.

On a four tier plan there is one rate for employee only, one for employee plus a spouse, one for employee plus a child or children (because of the possibility of multiple children, this is higher than the cost of an employee plus a spouse) and finally one for "full family" - employee, spouse and children.

In 37 years of direct contact I have never - NEVER seen or heard of a plan where the exact number of dependents determined the rate. If both of you have four tier plans then your family coverage would be employee plus children and hers would be full family, but that is the only instance when the number of dependents you are covering would affect the amount you pay. In other words, just because your family plan would have only three people on it and hers would have six doesn't mean that there's automatically going to be a huge discrepancy in the family rate.

And before someone, probably LdiJ, gets on here and tells me that THEY'VE seen plans where the employee pays nothing for him/herself and the employee pays only for the dependents, I will acknowledge that yes, some employers have been known to do it that way. They are, however, not the norm, and even when that does happen the dependent rate is rarely if ever per-person. Yes, I do know that for sure.

I'm not saying the other posters are wrong; I'm saying don't assume that the number of dependents covered is going to have a huge difference on the rate.

I think that you misunderstood me cgb. I never suggested that the number of dependents determined the premium rate. I said that the court normally divided the cost of the insurance that covered the dependents by the number of dependents to determine how much should be reimbursed to the parent providing the insurance, by the other parent.

I also said several times that his children were basically free on stepdad's policy because they already needed a family plan to cover their own children, so I think its pretty clear that I understand that the premium rates do not depend on the number of dependents.

Maybe I should give an example of what I mean. If it costs 200.00 a month to cover stepdad, and a full family policy is 600.00 a month, then you divide 400.00 by 5 people (wife and 4 children) to determine how much dad (in this instance) should reimburse mom. The reimbursement for two kids would be 160.00 and dad might have to reimburse 1/2 or all of that, depending on his court order.

 

[cbg]

No, I agree you didn't say the cost was determined by the number of dependents. The OP did.

But you are the one who tends to tell me that things aren't really the way I say they are, and you know of a case where it was the exact opposite. Even when we're in my field rather than yours. So I figured this time I'd just head you off.

I wasn't talking about the math the judge would do, in any case. I was talking about the way the overall premiums are determined. And here you are, telling me I'm wrong.

 

[LdiJ]

No, I agree you didn't say the cost was determined by the number of dependents. The OP did.

But you are the one who tends to tell me that things aren't really the way I say they are, and you know of a case where it was the exact opposite. Even when we're in my field rather than yours. So I figured this time I'd just head you off.

I wasn't talking about the math the judge would do, in any case. I was talking about the way the overall premiums are determined. And here you are, telling me I'm wrong.

That statement is disappointing, since I did not in any way say that you were wrong. I defended myself against a statement attributed to me that I did not say nor have any intention of saying. I do not even disagree with you often. In fact I disagree with you rarely.

 

[cbg]

But I didn't attribute the statement to you. You assumed I was doing so, but that was not my intent. I will apologize for not making that clear.

I owe you another apology as well. You actually do it more often than I think you realize, but I shouldn't have mentioned it this way - that wasn't fair to you. I've just had a whole lot of people on both this and other boards who have suddenly decided they know better than I do how Benefit issues work and have been "correcting" me, even though I work with them 40 hours a day, 48 weeks a year if I take all my vacation which I usually don't, and I can show them the laws that say they're wrong. It wasn't fair to take it out on you. I'm sorry.

 

[NC Parent]

Maybe I should give an example of what I mean. If it costs 200.00 a month to cover stepdad, and a full family policy is 600.00 a month, then you divide 400.00 by 5 people (wife and 4 children) to determine how much dad (in this instance) should reimburse mom. The reimbursement for two kids would be 160.00 and dad might have to reimburse 1/2 or all of that, depending on his court order.

Well, it seems her lawyer made her see the light. Just one question... It is always employee+family- employee divided by 5, or is it employee+family- employee+spouse divided by 4? The jump between employee and employee + spouse is substantial and it seems like I'd be contributing to her coverage as well.

Mediation ball is finally rolling, so is this something we would work out in mediation or is it definitely one way over the other?

Thank you.

 

[cbg]

There is no across the board formula that is used exclusively. That is the point I was trying to make to begin with.

Where I work, there is only individual and family. Either it's just you and no one else, or you pay family rates. You pay exactly the same rate if you're only covering one dependent or if you're covering eight dependents. I am covering only my husband, and I pay almost three times as much as I would pay if it were just me. But I'd be paying exactly the same amount if I were also covering three children. The amount I would be paying wouldn't change, but the amount per person would.

There simply isn't a single formula that is always used universally.

 

[stealth2]

In MY situation (which involved none of the states you mentioned in your other thread), my ex was ordered to cover our kids. When we both moved to different states, his insurance was problematic to use in the state the kids and I were in - everything was out of network and he was not required to help with out-of-network costs. I covered them myself, and did ask (in conjunction with a different mod) that he be required to help cover the differential in cost to me. The judge said it was not Dad's fault that the insurance his employer offered was inconvenient and more expensive for me to use, so he was to continue carrying them on that and I was free to do as I liked - at my own expense. <shrug> Such is life.

 

[NC Parent]

In MY situation (which involved none of the states you mentioned in your other thread), my ex was ordered to cover our kids. When we both moved to different states, his insurance was problematic to use in the state the kids and I were in - everything was out of network and he was not required to help with out-of-network costs. I covered them myself, and did ask (in conjunction with a different mod) that he be required to help cover the differential in cost to me. The judge said it was not Dad's fault that the insurance his employer offered was inconvenient and more expensive for me to use, so he was to continue carrying them on that and I was free to do as I liked - at my own expense. <shrug> Such is life.

Thanks for sharing, stealth2. Sounds like a harsh decision for you!

Just making sure all my bases are covered before I agree to anything. I'd like to start making these reimbursements asap so I don't accrue any more back payments rather than wait until mediation.

 

[NC Parent]

There is no across the board formula that is used exclusively. That is the point I was trying to make to begin with.

Where I work, there is only individual and family. Either it's just you and no one else, or you pay family rates. You pay exactly the same rate if you're only covering one dependent or if you're covering eight dependents. I am covering only my husband, and I pay almost three times as much as I would pay if it were just me. But I'd be paying exactly the same amount if I were also covering three children. The amount I would be paying wouldn't change, but the amount per person would.

There simply isn't a single formula that is always used universally.

Thanks cbg. Step Dad insurance does offer plans for employee, employee + spouse, employee + Children, and Employee + family. See your point that if each insurance plan can vary, the court system probably doesn't have a set decision.