Enforcement of Medical Expenses by FOC
The law requires the FOC to enforce the medical support provisions of your support order. Before a complaint of non-payment will be accepted by the FOC you must first provide, within 28 days after the insurer's final payment or denial of coverage, the other parent with an itemized statement for each expense.
This statement must include the name of the child that received care, the date of the care, the reason and diagnostic code and cost, and the complete name and address of the healthcare provider. If applicable, a copy of your insurance carrier's explanation of benefits (the statement that tells why the insurance did or did not pay towards the expense and the amount paid) should be included.
You should use the REQUEST FOR HEALTH CARE EXPENSE PAYMENT form, found in downloadable forms on this website, to request payment from the other parent.
If the other parent does not pay his or her share of the claimed expenses with 28 days of the date you provided the itemized statement to that parent, by way of the REQUEST FOR HEALTH CARE EXPENSE PAYMENT form, then you may file a Complaint with the FOC. To file a non-payment complaint with the FOC, COMPLETE THE COMPLAINT AND NOTICE FOR HEALTH CARE EXPENSE PAYMENT form, found in downloadable forms on this website, and turn this document into the FOC. DO NOT FILE THIS FORM IN THE CLERK'S OFFICE. THIS IS AN ADMINISTRATIVE PROCESS THAT IS DONE THROUGH THE FOC OFFICE.
A complaint must be submitted to the FOC on or before any of the following:
• One year after the expense was incurred.
• Six months after the insurers' final payment or denial of coverage for the expense.
You will be required to attend all appointments, conferences and hearing about the bills. If you fail to attend, your claim may be dismissed. You will also be required to produce a copy of an itemized bill for each expense, receipts showing any payments made and any related correspondence with the provider of service or the other parent. These documents are needed to prove your case.
After verifying that the annual ordinary healthcare amount has been exceeded and that the correct process of the law has been followed, the FOC will send the formal request for payment to the other parent. If the parent does not pay the bill or object and request a hearing, the amount will be added as a support arrearage to your case, or credited to the support balance.
You also may start enforcement using a private attorney. The FOC makes no distinction between parents who receive support and parents who pay support when dealing with healthcare bills for children. These are shared responsibilities unless your order says otherwise. If you have paid for healthcare bills for your children, you can use the enforcement processes of the FOC even if you are the person who pays child support.
Provisions requiring one or both parents to maintain health insurance for the children, if such insurance is available through a parent's employment, are required in the following:
• Judgments of Divorce involving a child
• Orders involving a child of unmarried or separated parents.
• Modifications to existing judgments and orders.
If your order requires that you maintain health insurance for your children and it is available through your employer, you must provide such coverage even if you have to pay a premium, provided that the premium is determined to be a "reasonable cost" under the provisions of state and federal law. If the amount being paid for child support, childcare and your portion of the healthcare premium exceed 50% of your wages after taxes, union dues and/or uniform charges, the cost is considered unreasonable. If the amount you would be required to pay for healthcare insurance premiums exceeds five (5%) percent of your gross income, that is also considered to be unreasonable.
If coverage is not maintained through parent's employer and coverage is available, a National Medical Support Notice (NMSN) will be forwarded to the employer with a copy to each parent. This is required by federal law. The NMSN requires the employer to enroll the children listed on the form for all insurance types available. If there is a cost for insurance coverage a parent must pay. The employer must tell the FOC what the cost is, along with other information regarding the coverage.
If the employer determines that the employee's wages do not allow the enrollment of the children on the available insurance, the employer must provide documentation to the FOC. If the employer does not deem the insurance cost to be unreasonable but the parent believes the cost is excessive, the parent may write the FOC to object to having to provide the insurance and request a review. The written request must include the date, the case/docket number, be clearly labeled "Insurance Review Request", and include the basis for the objection and the signature of the objecting parent.
If your court order does not specifically designate whose insurance is primary (is billed first), the insurance carriers will determine this by rules they follow.