All orders for support will address medical insurance and the payment of unreimbursed medical expenses by both parties. The Court may also order one or both parties to maintain insurance coverage if it is available at a reasonable cost through employment or other group basis. A party’s payment of an insurance premium to provide coverage on behalf of the other party or the children will be allocated between the parties in proportion to their incomes. The party providing the coverage will also be ordered to provide the following:
- Name of health care coverage provider(s);
- Any applicable identification numbers or cards;
- Address to which claims should be mailed;
- All documentation regarding guidelines and participating health care providers, including a copy of the benefit booklet or coverage contract
- Five copies of any claim forms.
Medical support also includes reasonable expenses for medically necessary services and supplies, which are not reimbursed by insurance, such as:
- Co-pays and deductibles
- Surgical expenses
- Dental expenses
- Optical expenses
Please note, however, that since the first $250.00 per year, per child in unreimbursed medical expenses is built into the basic guideline amount, the custodial parent will be responsible for payment of this amount prior to any expenses being allocated to the non-custodial parent.
Medical Support Enforcement
The Domestic Relations office will enforce medical support obligations in the same manner as other support obligations, once the custodial parent provides documentation that the $250.00 per child, per year has been met.
If either party has incurred medical expenses that should be allocated between the parties, and they are unable to get reimbursed directly from the other party, then the bills in question should be forwarded to the Domestic Relations office.
Please note that the office cannot seek reimbursement if insurance company rules and procedures have not been followed
When submitting bills to the Domestic Relations Office, they must clearly state the date of service, medical provider, and the patient’s name. The bill must also show all charges, insurance reimbursements and amount paid by the parent. The office cannot accept bills which indicate “balance forwarded.” Any explanations or denials of benefits from the insurance companies must also be submitted as verification of the actual amount paid by the party.
The office representative will review the bills for accuracy, and determine the amount to be charged to the other party. That party will then be sent a letter detailing the charges and requesting payment in full within thirty (30) days. If not paid within that time frame and no other agreement has been reached, the Domestic Relations office will take appropriate enforcement actions.
The Pennsylvania Rules of Civil Procedure require that documentation of unreimbursed medical expenses that either party seeks to have allocated between the parties shall be provided to the other party not later than March 31st of the year following the calendar year in which the final bill was received by the party seeking allocation. Allocation of the unreimbursed medical expenses for which documentation is not timely provided shall be within the discretion of the Court.