I promised the entirety of the proposed guideline for the new Health Care / Medical Support guideline. Pardon the formatting, I had to copy this over from the original PDF format.
The court shall order one or both parents to provide private health care insurance when accessible to the child at a reasonable cost.
AccessabilityAccessibility. Insurance is accessible if it covers the geographic area in which the child lives. The court may consider other relevant factors such as the managed care regions used by Hoosier Healthwise, the accessibility and comprehensiveness of covered services and likely continuation of coverage.
Reasonable cost. The cost of health insurance for child(ren) is considered reasonable, if it does not exceed five percent (5%) of the weekly gross income of the parent obligated to provide medical support. The cost of health insurance for the children is not considered reasonable when it is combined with that party’s share of the total child support obligation (line 6 of the worksheet) and that sum exceeds fifty percent (50%) of the gross income of the parent responsible for providing medical support.
A consideration of the foregoing factors is addressed in the Health Insurance Premium Worksheet, which should be utilized in determining the appropriate adjustments for the children’s health insurance on the Child Support Obligation Worksheet.
Cash medical support. When private health care insurance is not accessible to the children at a reasonable cost, federal law requires the court to order the parties to pay cash medical support. Cash medical support is an amount ordered for medical costs not covered by insurance.
The uninsured medical expense apportionment calculation on the Child Support Obligation Worksheet, “the 6% rule,” satisfies this federal requirement for a cash medical support order, when incorporated into the court order.
Explanation of 6% rule/uninsured health care expenses. The data upon which the Guideline schedules are based include a component for ordinary health care expenses.
Ordinary uninsured health care expenses are paid by the parent who is assigned to pay the controlled expenses (the parent for whom the parenting time credit is not calculated) up to six percent (6%) of the basic child support obligation (Line 4 of the child support obligation worksheet.) Extraordinary health care expenses are those uninsured expenses which are in excess of six percent (6%) of the basic obligation, and would include uninsured expenses for chronic or long term conditions of a child. Calculation of the apportionment of the health care expense obligation is a matter separate from the determination of the weekly child support obligation. These calculations shall be inserted in the space provided on the Worksheet.
Birth expense. The Court may order the father to pay a percentage of the reasonable and necessary expenses of the mother’s pregnancy and childbirth, as part of the Court’s decree in child support actions. The costs to be included in apportionment are pre-natal care; delivery; hospitalization; and post-natal care. The paternity statutes require the father to pay at least 50% of the mother’s pregnancy and childbirth expenses.
Commentary
Health insurance premiums.
The court is federally mandated to order accessible health care insurance if the cost is at or below 5% of the weekly gross income of a parent as indicated in the child support obligation worksheet. If above 5% of weekly gross income, the court has discretion to require the health insurance premium be paid by a parent if the court indicates the reason for the deviation.
The court is federally mandated to order accessible health care insurance if the cost is at or below 5% of the weekly gross income of a parent as indicated in the child support obligation worksheet. If above 5% of weekly gross income, the court has discretion to require the health insurance premium be paid by a parent if the court indicates the reason for the deviation.
Health insurance coverage should normally be provided by the parent who can obtain the most comprehensive coverage at the least cost. If a separate policy of insurance is purchased for the children, determining the weekly cost should be no problem, but in the most common situation coverage for the child(ren) will occur through an employer group plan. If the employer pays the entire cost of coverage, no addition to the basic obligation will occur. If there is an employee cost, it will be necessary for the parent to contact his or her employer or insurance provider to obtain appropriate documentation of the parent's cost for the child(ren)'s coverage.
At low income levels, giving the noncustodial parent credit for payment of the health insurance premium may reduce support to an unreasonably low amount. In such instance the Court may, in the exercise of its discretion, deny or reduce the credit.
A number of different circumstances may exist in providing health insurance coverage, such as a situation in which a subsequent spouse or child(ren) are covered at no additional cost to the parent who is paying for the coverage. The treatment of these situations rests in the sound discretion of the court, including such options as prorating the cost.
There may be situations where neither parent has the opportunity or ability to afford health insurance. Where one or both parents have a history of changing jobs and/or health insurance providers both parents may be ordered to carry health insurance when it becomes available at reasonable cost to the parent. Where one parent has a history of maintaining consistent insurance coverage for the children, there is no need to order both parents to provide health insurance for the children. The court may order both parents to provide health insurance and in those cases both parents should have the cost of the children’s portion of the health insurance premium included in the calculation of the support order. In such cases both parents receive a credit.
Apportionment of Uninsured Health Care Expenses. Six percent (6%) of the support amount is for health care. The non-custodial parent is, in effect, prepaying health care expenses every time a support payment is made. Consequently, the Guidelines require that custodial parent bear the cost of uninsured health care expenses up to six percent (6%) of the basic child support obligation found on Line 4 of the child support obligation worksheet and, if applicable, the child support obligation attributable to a student living away from home (Section Two Line I of the post-secondary education worksheet).
That computation is made by multiplying the total of Line 4 and Line I by 52 (weeks) and multiplying the product of that multiplication by .06 to arrive at the amount the custodial parent must spend on the uninsured health care costs of the parties' child(ren) in any calendar year before the non-custodial parent is required to contribute toward payment of those uninsured costs. For example, if line 4 is $150.00 per week and Line I is $25.00 per week, the calculation would be as follows: $150.00 +
$25.00 = $175.00 x 52 = $9,100.00 x .06 = $546.00.
Thus, on an annual basis, the custodial parent is required to spend $546.00 for health care of the child(ren) before the non-custodial parent is required to contribute. The custodial parent must document the $546.00 spent on health care and provide the documentation to the noncustodial parent.
After the custodial parent's obligation for ordinary uninsured health care expenses is computed, provision should be made for the uninsured health care expenses that may exceed that amount. The excess costs should be apportioned between the parties according to the Percentage Share of Income computed on Line 2 of the worksheet. Where imposing such percentage share of the uninsured costs may work an injustice, the court may resort to the time-honored practice of splitting uninsured health care costs equally, or by using other methods. The court may prorate the custodial parent’s uninsured health care expense contribution when appropriate.
As a practical matter, it may be wise to spell out with specificity in the order what uninsured expenses are covered and a schedule for the periodic payment of these expenses. For example, a chronic long-term condition might necessitate weekly payments of the uninsured expense. The order may include any reasonable medical, dental, hospital, pharmaceutical and psychological expenses deemed necessary
for the health care of the child(ren). If it is intended that such things as aspirin, vitamins and band-aids be covered, the order should specifically state that such non-prescription health care items are covered.
There are also situations where major health care costs are incurred for a single event such as orthodontics or major injuries. For financial reasons, this may require the custodial parent to pay the provider for the amount not covered by insurance over a number of years. The 6% rule applies to expenses actually paid by the custodial parent each year.
Birth expenses. There is no statute of limitations barring recovery of birthing expenses, providing the paternity, Title IV-D or child support action is timely filed. The court should be very careful to insure the claimed expenses are both reasonable and necessary. Birthing expenses include both the expenses incurred by the child as well as by the mother, providing they are directly related to the child’s birth. The court should distinguish between “postpartum expenses” and “postnatal expenses.” “Postpartum” expenses are mother’s expenses following the birth of the child. “Postnatal” expenses of the child are those expenses directly related to the child’s birth. Between the two, only “postnatal” expenses are reimbursable.
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