Pennsylvania law provides rules that govern which party is responsible for maintaining heath insurance coverage in divorces and in child support matters. The law also provides the court with guidance regarding how to allocate the cost of such insurance between the parties.
Who is Responsible for Provides Health Insurance Coverage?
In child support cases, where family health insurance is available to one or both parties through their employment at a reasonable cost, the court will require one of the parties to provide insurance for the children. If such insurance is only available to one party through their employment, that party will be the one required to provide the insurance coverage for the children. If health insurance is available to both parties through their employment, then the court will look at a variety of factors to determine which party should be responsible for providing the insurance coverage, including who currently provides insurance for the children, the benefits available under each plan, and the additional costs to insure the children under each plan. In child support actions where medical coverage is not available through either party’s employer, the court may require the primary custodial parent to apply for government-sponsored coverage, such as Pennsylvania’s Children’s Health Insurance Program (“CHIP”).
In divorce cases (and spousal support actions) if health insurance is not available to one of the parties through his or her employment, or if the insurance offered is sub-standard, and family health care coverage is available to the other party at no cost or a reasonable cost as a benefit of employment, then the court will require that party to extend health care coverage to the other spouse.
How is the Cost of the Premium Allocated?
The cost to provide heath insurance coverage for the parties and their children, as applicable, is generally allocated between the parties in proportion to their respective net incomes. That amount is then factored into the overall support order. For example, if a husband is providing family health insurance coverage for himself, his wife and children at a monthly cost of $500.00 and husband earns 60% of the parties’ net monthly income and wife earns 40% of the parties’ monthly net income, then Wife will be responsible for contributing $200 per month towards the insurance. Wife’s contribution to the insurance would be offset against any child and spousal support or alimony pendente lite that husband owes to wife.
Unreimbursed Medical Expenses
In addition to requiring a party to provide heath insurance for a spouse and/or children, and allocating the monthly cost of the health insurance premiums as set forth above, the court will also generally require the payor-spouse/parent (the party owing spousal or child support) to pay a percentage of the other spouse’s and/or children’s unreimbursed medical expenses in excess of $250.00 per person per year. Co-pays for office visits and prescriptions are examples of such out-of-pocket expenses. The payee (the party receiving support) is required to pay for the first $250.00 in unreimbursed medical expenses per person covered by the support order. After reaching the $250.00 threshold amount, the parties normally split the unreimbursed medical expenses in proportion to their net incomes. That amount is paid outside of the support order and any reimbursement will be a direct payment from one party to the other.
Can I Remove my Spouse from my Current Health Insurance Plan While Divorce is Pending?
Although it depends on the circumstances of your case, the short answer is probably no. Under Pennsylvania support law, the court may require that a payor-spouse pay a designated percentage of the payee-spouse’s reasonable and necessary health care expenses. If health care coverage is available at no cost as a benefit of employment or at a reasonable cost to one party, the court will order that party to extend health care coverage to the other spouse.
For the majority of cases, that means that the coverage that was in place at the time of separation must be maintained while the divorce is pending. If you remove your spouse from your employer-sponsored health insurance plan that you receive at no cost or at a reasonable cost, you can be ordered to reinstate the cancelled coverage and could be held responsible for medical expenses incurred by the payee-spouse as a result of the gap in coverage.
When does the Obligation to Provide Heath Insurance Coverage End?
Generally, the obligation to provide heath insurance coverage for children ends when they turn 18 or graduate from high school, whichever is later. The obligation to provide heath insurance coverage for a spouse ends upon entry of a divorce decree, absent agreement otherwise. However, in both cases, the obligation may end sooner if insurance is no longer available through employment at a reasonable cost.