Health Insurance Coverage for Children as Child Support

California Family Code includes how health insurance coverage should be handled during child support proceedings. These sections address not only the obligation to provide health insurance for children but also the rights and responsibilities of both parents and the role of insurers and employers. This article summarizes California Family Code Sections 4006, 3751, and 3751.5. It explains how these laws work together to secure health coverage for supported children and ensure parents fulfill their obligations.

Section 4006: Health Insurance Coverage as a Factor

This section mandates that the court must consider the health insurance coverage of all parties involved in any child support proceeding under the Family Code, including those under Division 17.

Section 3751: Health Insurance for Supported Child

This section outlines several key points regarding health insurance for supported children:

  1. Child support orders must include a provision requiring the obligor to inform the relevant agency about their health insurance coverage status and details.
  2. When setting current support, the court must require that either or both parents maintain health insurance for the child if it's available at no cost or reasonable cost.
  3. "Reasonable cost" is presumed to be no more than 5% of the parent's gross income, calculated as the difference between self-only and family coverage.
  4. Unless the court determines otherwise, medical support may be deemed unreasonable for low-income parents.
  5. If health insurance is not currently available at a reasonable cost, the order must specify that it should be obtained if it becomes available.
  6. The order must require the parent providing coverage to seek continuation of coverage for the child upon reaching the limiting age for dependents if the child meets specific criteria and the coverage remains reasonably priced.

Section 3751.5: Prohibited Grounds for Denial of Coverage and Employer/Insurer Obligations

This extensive section covers several aspects:

  1. Insurers and employers cannot deny enrollment of a child under a parent's health insurance based on the child being born out of wedlock, not being claimed as a tax dependent, or not residing with the parent or in the insurer's service area.
  2. When a parent is required by court order to provide health insurance for a child, the employer or insurer must:
    • Allow enrollment of the child without regard to enrollment period restrictions.
    • Enroll the child if the parent fails to do so upon presentation of the court order or request by authorized parties.
    • Not disenroll the child unless family coverage is eliminated for all employees, there's evidence the order is no longer in effect, or the child has comparable coverage elsewhere.
  3. Insurers must provide all relevant information about the child's coverage to the noncovered parent or person having custody and to the local child support agency when requested.
  4. Insurers must allow the noncovered parent or custodian to submit claims and receive payments directly.
  5. The section defines "insurer" broadly, including various health coverage providers and plans.
  6. It defines "person having custody" as legal guardians, authorized caregivers, or persons with whom the child resides.
  7. Insurers must notify both parents in writing if the child's health insurance is terminated.
  8. The section outlines conditions under which these requirements apply, such as the presence of a qualified medical child support order.
  9. It grants the noncovered parent or custodian the right to request and receive information about the child's health insurance coverage directly from the insurer.

These sections intend to give minor children access to health insurance coverage as part of child support arrangements and state that both parents have equal rights and responsibilities.