Mom and Dad don’t live together anymore. Your child has two beds, two sets of teddy bears, two groups of friends, and two homes. And, as the years go by, these two homes may be further and further apart. It’s important that your child has health coverage in both homes. But how will you achieve this? And who will pay for it?
Just one trip to the emergency room may result in many large medical bills. Health care costs can add up quickly, so you’ll want to make provisions for your child’s continued health coverage as soon as possible.
Here’s what you need to know:
You’ll need to decide who will be responsible for your child’s health coverage, and how it will be obtained – through your employer? your ex’s employer? both? If neither of you are eligible for group coverage, then you’ll want to decide how you plan to keep your child covered, and who will be bearing the costs, if any. Make sure you put these decisions in writing!
Residence is not a factor. Parents sometimes assume that they’re not responsible for their child’s health coverage because the child no longer lives with them. Not true! A custodial parent may, at any time, file a Qualified Medical Child Support Order (QMCSO) to get health coverage for their child through the other parent’s employer-provided health plan. A QMCSO may also require that the premium be deducted from the non-custodial parent’s paycheck or that the non-employee parent be made aware of all aspects of the healthcare plan.
You’ll need to know the geographic boundaries of your child’s health plan. Many managed care plans do not provide coverage outside a certain geographical area.
A fee-for-service policy sometimes provides better geographic reach than HMOs and PPOs that restrict you to one primary care physician. Talk with your employer, or your ex-spouse’s employer, about your options. Note: Some specially-designed plans allow children to be added as guest members during their stay with their non-custodial parent.
Both parents can include (or add) the child in their group health plan. While experts often advise against such double coverage for most families, children of divorced parents often benefit greatly. Double coverage can help keep your child covered at both houses, even if they are miles apart. The plans are designated as "primary" and "secondary." The secondary plan will cover many of the costs not covered by the primary plan, including expenses outside the coverage area of the primary plan.
Which is which? To decide which parent holds the primary plan, health insurance companies commonly use the birthday rule. The plan of the parent with the first birthday of the calendar year becomes the primary plan. (The birth years don’t matter)
Hold on to any group health plan you have at the time of the divorce. Individual plans may be able to reject your child if he or she has any medical conditions such as asthma or frequent ear infections. (Rules vary by state.) They can also accept your child but refuse to pay for pre-existing conditions.
If your child has an ongoing or recurring health problem, you’ll want to make every attempt to maintain continuous group health plan coverage throughout the divorce proceedings and beyond. Group plans are the only plans not allowed to reject the child or limit coverage due to pre-existing conditions (unless there’s been a significant gap in coverage).
No group health plan available? You may want to purchase individual insurance for your child. Shop carefully; the cheapest plan might not be the best value if it doesn’t offer the most-needed benefits. Individual plans don’t often include preventive care.
Can’t afford individual insurance? HealthCareCoach.com has articles about children’s health insurance that you can afford. If you are a moderate-income family you may be able to qualify for the State Children’s Health Insurance Program. If your family’s income is lower, your children may qualify for Medicaid.