Guideline 7. Health Care / Medical Support
Effective January 1, 2024
The court shall order one or both parents to provide health insurance when accessible to the child at a reasonable cost. Health insurance may be public, for example, Medicaid, or Children’s Health Insurance Program (CHIP), Hoosier Healthwise, or private, for example, Affordable Care Act (ACA) or employer-provided.
Accessibility.
Health insurance is accessible if it covers the geographic area in which the child lives. The court may consider other relevant factors such as provider network, comprehensiveness of covered services and likely continuation of coverage.
Reasonable Cost.
There is a rebuttable presumption that parents have health insurance available at a reasonable cost. The presumption may be rebutted by demonstrating that the lowest out of pocket cost of insuring the child(ren) is more than 5% of the parents’ combined gross incomes. The lowest out of pocket cost health insurance available may be public insurance.
Cash Medical Support.
When health insurance is not accessible to the child(ren) 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, satisfies this federal requirement for a cash medical support order, when incorporated into the court order.
Uninsured Health Care Expenses.
The data upon which the Guideline schedules no longer include a component for ordinary health care expenses. The Guideline schedules have been adjusted accordingly. Routine non-prescription personal care expenses such as over-the-counter medications, bandages, and vitamins which do not travel with the child and are kept in the purchasing parent’s home are paid by the parent exercising parenting time when the expense is incurred. The parents shall share responsibility for uninsured health care expenses in proportion to their incomes. Uninsured health care expenses are defined as any health care expenses remaining after a claim has been submitted to the child’s health insurance carrier. Uninsured health care expenses may include, but are not limited to, claims applied to the policy’s deductible, claims in excess of policy limits, or the patient’s responsibility after payments or discounts from the insurance carrier have been applied.
To request contribution from the other parent, copies of all documentation relating to the insurance claim and expenses paid or incurred by a parent must be provided to the other parent within thirty (30) days of receipt or the expense may be ineligible for contribution. Expenses paid at the time of service shall be submitted within thirty (30) days of the receipt of service.
Birth Expense.
Upon the establishment of paternity, the court shall order the father to pay at least fifty percent (50%) of the reasonable 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, other necessary and reasonable expenses incurred in connection with the child’s birth; post-partum expenses; and post-natal care.
Commentary
Health Insurance Coverage and Costs.
The court is federally mandated to order parents to obtain health insurance if accessible at a reasonable cost. The rebuttable presumption that all children have insurance available at a reasonable cost recognizes (1) both public and private insurance can be used to satisfy the federal mandate to insure children, (2) the availability of guaranteed acceptance for policies, and (3) the availability of tax credits for the purpose of obtaining health insurance.
Health insurance coverage should normally be provided by the parent who can obtain the most comprehensive coverage at the least out of pocket cost. The parents bear the burden of demonstrating to the court the out of pocket cost of health insurance for the child(ren) exceeds 5% of the parents’ combined gross incomes. A parent shall provide the court with proof of existing public or private health insurance for the child(ren) through an employer, a retirement plan, Tricare, a Veteran’s Health Care Program, Medicaid, or the Children’s Health Insurance Program (CHIP). If the child is not currently covered, the parent must provide the court with proof of the cost of health insurance. (Please refer to Guideline 3, E. 2. for additional information regarding determining the cost of insurance coverage.)
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 a reasonable cost to the parents. Where one parent has a history of maintaining consistent insurance coverage for the child(ren), there may be no need to order both parents to provide health insurance for the child(ren).
Parental Self-Monitoring and Compliance.
Parents should cooperate with one another to ensure the child(ren) remain insured at all times. The court should order the parent providing health insurance to show proof of coverage; provide insurance cards, claim forms, website addresses, and any other material to permit claims to be filed with the insurance carrier; and give notice of any coverage changes, including termination of coverage, to the other parent. See Indiana Parenting Time Guidelines I, D. paragraph 5.
Apportionment of Uninsured Health Care Expenses.
An earlier economic model estimated uninsured health care expenses to be 6% of the Basic Child Support Obligation. That model is out-of-date and is no longer utilized in the development of the current Guideline support schedule. In addition, the former “6% Rule” often required burdensome record-keeping and proved to require excessive use of judicial resources to enforce. Consequently, the Guidelines require the parent exercising parenting time bear the cost of routine non-prescription personal care expenses which are not normally submitted to the child’s health insurance carrier for payment or reimbursement. These expenses are part of the basic child support obligation and the parenting time credit. When a claim is submitted to the health insurance carrier, the parties should contribute to the uninsured portion of the claim in proportion to their incomes as shown in the Child Support Obligation Worksheet.
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 and medically necessary medical, dental, orthodontic, hospital, vision, pharmaceutical and psychological expenses for the child(ren). The court may consider the reasonableness of the use of out-of-network providers. The order may exclude from contribution any claims rejected for failure to obtain preapproval for particular procedures or health care providers.
There are also situations where major health care costs are incurred which may require the parents to pay the provider for the amount not covered by insurance over time, for example, long term orthodontic treatment, major injuries or long-term chronic conditions. The apportionment of the uninsured health care expenses applies to expenses actually paid by the parents.
Birth Expenses.
There is no statute of limitations barring recovery of birthing expenses, providing the paternity action is timely filed. The court should be very careful to be sure the claimed expenses are reasonable. 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. Under current law, both postpartum and postnatal expenses are now reimbursable, as well as other necessary and reasonable expenses incurred in connection with the child’s birth. The father must be ordered to pay at least fifty percent (50%) of the expenses, although the court has discretion to order father to pay a higher percentage.
Version History
| Effective | Obsolete | Amended |
|---|---|---|
| current | - | - |
| 01-01-2020 | 01-01-2024 | 10-17-2023 |
The version history for the Indiana Child Support Rules & Guidelines goes back only to January 1, 2020. For earlier versions, please see one of the many publishers of Indiana Rules of Court.