Court Ordered Coverage for Dependents

LindaS

I have an employee who is married to someone who has children with a former spouse. The employee's spouse is not currently working and he wants to add his step-children to our plan. He also has a court order from his spouse's divorce which states that health coverage must be maintained for the minor children and it must be done by either of the parties involved or their spouses. The order also maintains that joint custody is maintained.

I just spoke with our TPA and was informed that our plan does not recognize court orders for spouses. The way it was explained was that the children are not eligible dependents because of the joint custody situation and on top of that the court order is not from the dissolution of the employee's marriage but that of his spouse.

I always thought that court orders were to be followed or we could be fined or in some way made to follow the order. Am I incorrect in this assumption? Has anyone else heard of something like this in their health plans?

Don D

The court order in this case was not directed at the employer. The employee is the recipient of the court order and is obligated to follow it. That obligation does not roll down to you. On the other hand, as you know, if the court order ordered the employer to withhold and transfer certain sums of money, that would be an obligation. We've had a similar case where the children did not qualify as dependents under our plan. The ee had the obligation to shop for and provide coverage under another plan. If he didn't, the court dealt with HIM, not us.

bsa

The court order for medical coverage is not addressed to you as the employer. The employee's spouse and her ex-spouse are the ones who are required by the courts to maintain coverage. The parents would have to go to the courts and requested an order be addressed to you as the employer, but it's not likely to happen since you do not employ either parent.

If the children lost coverage when the spouse lost her job, then this might be a qualifying event and enrollment could be allowed. Your carrier may require that enrollment after a qualifying event happen within 30 days of the event. Ask again without "joint custody" entering the picture (don't ask, don't tell). If that approach fails, then open enrollment would be their next opportunity to enroll the children. ALL of these scenarios are subject to the particulars of your plan set up. In the meantime, they should elect COBRA with her former employer.

Theresa Gegen TX

Look very closely at what the actual plan says about who is an eligible dependant. Don't just take the TPA's word for it. Even if the order is not directed at the plan per se, bad things can happen if you fail to exhaust the reasons about why you are not adding the children. Make sure all your ducks are in a row.

A state court judge could call you down and question you about it (this has happened, state court judges can get very upset if they think people are ignoring their orders or if they think that minor children will be hurt), and make almost any order that he wants to. Your plan may prove, after expending a few thousand dollars, that it is legally in the right, but the cost can be high.

I suggest that you determine whether or not these children are eligible based on the written terms in the plan, and determine whether or not they can now be added based on the law (has that type of event occured). Then explain to the employee in writing in clear, easy to understand language, why they cannot be added. Give the employee a copy of the relevant provisions of the plan. Then the employee can decide if he needs to take further action (like change the custody arrangements, so that he is primary and they can be covered) or secure alternate insurance coverage.

Good Luck!

cthr

I would check your plan documents to see what the definition of a dependent is. When my step daughter started college in another state and lost coverage under her mother's medical plan the court ordered my husband to provide coverage. Since he was covered by my insurance we added her to my plan. The insurance company had no issue. I don't recall that they even asked for a copy of the court order.

jassie

Currently it doesn't sound like you have to do anything. According to my company's current Health Care Plan. The court can issue a QMCSO (Qualified Medical Child Support Order)to your company. Which is practically the same as a child support order, that orders your employer to cover the child. This is the only way our health care plan will allow us to add the child outside of open enrollment period.

Balloonman

Now you all have me thinking. I have in the past received and Order To Enroll notice from the Division of Child Support Service regarding the children of our emplyees. It tells us that we must enroll the children immediately. Our health insurance begins the 1st of the month following 90 days of employment.
At the end of the letter it say that the order has the effect of a circuit court ordered QMCSO. But the last sentence says: It does not require a health benefit plan to provide any type or form of benefit, or any option, not provided under the plan.
My approach has been until the plan allows enrollment, I will not add the child. But once the parent is eligible then they must enroll themselves and the child. Does anyone see an issue with this? My approach has been our plan is what we follow and I do not let others dictate exceptions to our plan. I am in Missouri. Just wondering.
Balloonman

cthr

The state of CT recently enacted a law that is similiar. The child must be enrolled in the medical plan, but the employee must be eligible for the plan. Eligibility is the key requirement. There is usually a form that has to be returned that states if the employee is eligible and when the benefit will start.

LindaS

I would like to thank all of you for your responses. Over the past couple of days I have spoken with several individuals within our TPA and received some assitional information from our employee. Because the children do not reside with him and his wife at least 50% of the time and the ex-spouse claims them as a dependent on his tax return, they do not fall within our plan's definition of a dependent. If they did, a court order would not be necessary. Because they don't and the court order pertains to his spouse, although there is a statement that coverage needs to be provided by both parties or their spouses place of employment, our plan does not recognize this order. It still doesn't make complete sense to me (the court order part of it) and I am working with the president of the company to make a possible amendment to the plan.

Don D

We've had some of these same experiences with agencies and others, even attorneys at law, who attempt to mandate things not in accordance with the terms and provisions of our plan. In those cases, we have not had to deviate from our policies or the procedures of our plan. On an unrelated matter, we did get bit rather handily on the rump about six months ago when we (the accounting department, not HR) followed the instructions an attorney sent us. He advised that we were to from a certain date forward to send child support withholdings directly to the mother, not the welfare office. We did. We suffered. We wrote the attorney telling him that he was a dishonorable member of the profession. We also wrote the other players advising that we had considered all attorneys to be honorable officers of the court who would not knowingly misdirect us. He got a copy. He probably grinned but we felt better. It was an embarassment to say the very least. We always attempt first and foremost to follow court orders. But, we not been required to carve out exceptions regarding insurance coverage.

Terry

Don, sounds to me like that old mortgage scam. New Mortgage company says they have purchased your previous lender and here is the new address to send payments. You don't find out until you have sent them 2 payments that you are in arrears on your real mortgage and out the money sent to the "New" company. You should file a compaint with the state bar on this guy!

E Wart

E Wart
Linda, sounds as if you have solved your problem. The first thing you must do is examine your group document and abide by it. If the employee is eligible and the step child is eligible then you can add them. (Now when they can be added is another question.) Also, as mentioned previously, just because the court orders that the parent or step parent maintain coverage on the child, it doesn't automatically mean they are covered under your policy. The employee may have to go out an purchase an individual policy if they aren't. For example, what if you covered employee only and no dependents. Of course the step child would not be covered, even with the court order.
I believe our Plan states that step children can be covered only if they are a legal resident in the employees household (which sounds similar to your claiming for taxes). If and when the employee is eligible, then the dependent children would be. Now if the employee is eligible and has been covered and the step children are eligible and haven't been covered, and there is a court order issued, our plan has it that they can enroll immediately (within the 30 days for change of status). The child court order is one of the reasons listed in our "family status change" category.
I could go on and on, but will probably confuse you more.

Hope this helps.

funkysan

I have the same problem now. We have an employee who wants to add a step-child. The child lives with the ex-wife. The employee's spouse dosen't have a court order stating he must carry coverage. The only thing we were told was that the employee's spouse claims the child on his taxes. I don't believe I have to add this child to my insurance coverage. Since we are in the process of changing carriers I will first check the definition of dependent. However, is the fact that someone claims a child on his or her taxes legally require a company to add that child to the insurance coverage? Also, from what I have read am I correct in understanding that if the court order is toward the employee's spouse we still don't have to put the child on the insurance?

LindaS

When I spoke with our TPA, I was informed that the child first has to meet the definition of a dependent - we have several points that need to be met with this. If the child does, then they are added, regardless of the court order. If they do not, and there is NOT a court order FOR THE EMPLOYEE, they are not added. A court order for the spouse does NOT count if the child does not meet the definition in our plan. Regarding the tax status, in our plan that is just one aspect, they must also reside with the employee more than 6 months out of the year.