Medical Support

Who is responsible for providing medical support for the child?

Pennsylvania law gives the courts the authority to order either parent to provide medical support if it is available at no cost or at a reasonable cost. "Reasonable cost" is defined as an amount not to exceed five percent of the net monthly income. The incomes and assets of both parents are considered when the court establishes a support order. For detailed information about the support guidelines, please visit the Pennsylvania Child Support Website at www.childsupport.state.pa.us or use the link on the sidebar.  

Where can I get medical support for my child?

Medical support includes health coverage provided for a child or children in a child support case in which there is a medical support order. This includes private health insurance, publicly-funded health coverage such as Medicaid and Children's Health Insurance Program (CHIP), cash medical support including payment of health insurance premiums, and payment of medical bills (including dental and eye care). Medical support may be provided by either the custodial parent, noncustodial parent or any 3rd person associated with either parent such as a step-parent or grandparent.

How do I get medical support for a child?

Anyone who has custody of a child can apply for child support services at the county DRS of the Court of Common Pleas. The DRS will help people seeking child support set up a new support order or change an existing order to include medical support. 

The court:

• Will determine each parent's responsibility for the health care coverage for the child.
• Will decide which parent has primary responsibility for medical support; usually, it is the parent who has access to health care coverage at work at a "Reasonable Cost," which is:
  • Not more than five percent of the party's net monthly income; and
  • If the noncustodial parent is to provide the coverage, the total cost of the premium, the cash and other child support-related obligations are not more than the threshold set forth in the Federal Consumer Credit Protection Act.
• May require one or both parents to pay part of the expenses not covered by the health care coverage, including birth-related expenses that occurred prior to the application for support.
• Will enforce a court order if a parent who is ordered to provide medical support fails to do so.

What must the employer and the health care coverage plan administrator do?

When an employed parent is ordered to provide medical support, the employer and the plan administrator must comply with federal and state laws. A plan administrator who manages the health care coverage for an employer must:

• Make the health care coverage available to the child without regard to custody arrangements, seasonal or other enrollment restrictions or the child's residence.
• Enroll a child born out of wedlock or a child who is not claimed as a dependent on the federal income tax return of the parent without custody.
• Process and pay claims to the individual with custody of the child.
• Tell the individual with custody of the child about changes in the health care coverage.
• Provide health care benefit booklets to the individual with custody of the child.
• Allow the individual with custody of the child to enroll the child.
• Disenroll or eliminate coverage for a child only when:
  • Notified in writing that the court order is no longer in effect;
  • The child is enrolled or will be enrolled in comparable health care coverage beginning on the date of disenrollment;
  • The employer has eliminated family health care coverage for all employees;
  • Any available continuation coverage is not elected by the employer or the period of such coverage expires; or
  • The employee is no longer eligible for dependent health care coverage due to a change in employment status.

Getting the Facts About A Child's Health Care Coverage

By law, the person with custody of the child must receive the following information:

• The name of the administrator of the medical support;
• Health care cards and identification numbers;
• Instructions on how and where to file a claim;
• Claim forms; and
• Basic benefit facts, including deductible, co-payments and any restrictions on coverage.

The National Medical Support Notice

The National Medical Support Notice is a medical child support order that state child support enforcement agencies must use to enforce medical child support. The National Medical Support Notice is used when a parent is ordered to provide medical support for his/her child and is employed or in active military or reserve military duty. The county DRS sends the National Medical Support Notice to the employer. The employer and the medical support plan administrator must complete the National Medical Support Notice. The medical support information is then reported to the county DRS.

Confidentiality

The county DRS is responsible for maintaining the confidentiality and security of protected health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA). This includes information in health records including, but not limited to: names, addresses, telephone numbers, email addresses, medical/health plan numbers, Social Security numbers and birth dates.

For Your Information

The information contained in this handbook is not intended to give solutions for all situations. Each child support case has individual differences that may require special attention by a qualified professional at the DRS.

You can apply online for any of the commonwealth's health care coverage programs, including Medical Assistance and CHIP at www.compass.state.pa.us.