Qualified Medical Support Orders

President Obama's first term as President placed the issue of health care for Americans at the forefront and made it a frequent topic of the nation's daily conversations. The need to keep Americans, particularly children, insured and how to do so has been the subject of debates across the country, and the focus of individual states and the federal government. In the context of divorce, legislatures have placed mandatory requirements on parents to keep their children insured, and for spouses to keep each other insured, during the pendency of the divorce and beyond. This requirement to maintain health insurance is unique because legislatures and courts are reluctant to place obligations on divorcing parents above and beyond what is required of an intact family.

In Pennsylvania, for example, the Domestic Relations Code specifically requires either the custodial or noncustodial parent to provide “medical support to the children of the parties” “if medical support is available at a reasonable cost.” 23 Pa.C.S.A. ' 4326(c). The statute further defines “reasonable cost” as limited to 5% of the party's net monthly income or, if the party paying child support is also the party paying for the medical insurance, the combined expense of child support and medical coverage does not exceed the Federal threshold set forth in the Consumer Credit Protection Act.

In the States

Many states similarly require a spouse to maintain health insurance for his or her spouse subject to the same limitation that the cost of such health insurance be limited to a “reasonable cost”; however, unlike the obligation for children, the obligation to a spouse typically is limited to the pendency of the divorce and terminates when the parties are no longer “spouses.”

Because a spouse and the parties' children may be covered by the other party's health insurance, there are inherent logistical issues resulting from the fact that a spouse or parent may need access to information related to his or her own insurance benefits or the benefits of his or her children. Such issues may arise where that information is held by an insurance company that only recognizes the other party as the policy holder. In the custody context, where both parents share legal custody of the children, including decision-making authority related to medical issues, it is essential that both parents have equal access to information
related to the children's medical insurance coverage or information as to prescription drug use that could be obtained from the insurance company. Even if parents do not share legal custody, but the parent without legal custody still has periods of physical custody, it is still essential that that parent have access to information as to the child's medical insurance, regardless of whether he or she is able to make decisions as to the medical care.

Domestic Relations Codes

For a spouse whose medical coverage is held by the other spouse, the issue is as simple as the need for an adult to have access to information as to his or her own medical coverage and benefits.

To address the need for the insured spouse or a parent to have access to information related to their insurance benefits or their children's insurance benefits, many jurisdictions have created statutory obligations within their domestic relations codes requiring insurance companies to provide information and access to the spouse or parent, including claims information, explanations of benefits, benefit booklets and insurance contracts. Such statutes similarly instruct insurance companies to allow the spouse or parent to submit claims for covered services without going through the policy holder.

Qualified Medical Support Orders

To ensure that insurance companies are aware of their obligation to the non-policy holding spouse or parent, an increasing number of parties are entering into Stipulations for Qualified Medical Support Orders (QMSOs), in which the parties specifically set forth what information the non-policy holder (often referred to in the QMSO as the “alternate recipient” as opposed to the “participant”) is entitled to receive from the insurance company and how claims and reimbursements are to be handled. Such QMSOs make it clear to the insurance company that the alternate recipient is to receive information as to only himself or herself and the children, and not information related to the policy holder. Conversely, the OMSO will direct the insurance company not to allow the policy holder to have access to the alternate recipient's information. In other words, a QSMO puts the insurance company on notice that the benefit recipients are not functioning as an intact family that might otherwise share information.

A QMSO also may specifically provide that should the participant change employers, the obligations and rights set forth in the QMSO will apply to the subsequent employer's insurance company without the need to modify the underlying support order.

Whether or not to enter into a QMSO depends upon the facts of a particular case, since a basic support order generally includes the obligation of the insurance policy holder to maintain the coverage and many parties may be capable of cooperating in the exchange of insurance information. However, a QMSO can be an essential tool in ensuring that, where there is less cooperation, all parties have the necessary access to information without having to involve counsel in daily transactions with the insurance companies. Moreover, a QMSO may be the most effective way of alerting the insurance company to the fact that there is a court order requiring the participant to maintain coverage for the alternate recipient and the children so that the participant cannot unilaterally terminate the coverage leaving the other spouse and/or the children uninsured.

Charles J. Meyer, a shareholder with domestic relations firm Hofstein Weiner & Meyer, P.C, Philadelphia, is a fellow of the American Academy of Matrimonial Lawyers. Scott J.G. Finger is an associate with the firm. Both authors limit their practices to all facets of family law.

President Obama's first term as President placed the issue of health care for Americans at the forefront and made it a frequent topic of the nation's daily conversations. The need to keep Americans, particularly children, insured and how to do so has been the subject of debates across the country, and the focus of individual states and the federal government. In the context of divorce, legislatures have placed mandatory requirements on parents to keep their children insured, and for spouses to keep each other insured, during the pendency of the divorce and beyond. This requirement to maintain health insurance is unique because legislatures and courts are reluctant to place obligations on divorcing parents above and beyond what is required of an intact family.

In Pennsylvania, for example, the Domestic Relations Code specifically requires either the custodial or noncustodial parent to provide “medical support to the children of the parties” “if medical support is available at a reasonable cost.” 23 Pa.C.S.A. ' 4326(c). The statute further defines “reasonable cost” as limited to 5% of the party's net monthly income or, if the party paying child support is also the party paying for the medical insurance, the combined expense of child support and medical coverage does not exceed the Federal threshold set forth in the Consumer Credit Protection Act.

In the States

Many states similarly require a spouse to maintain health insurance for his or her spouse subject to the same limitation that the cost of such health insurance be limited to a “reasonable cost”; however, unlike the obligation for children, the obligation to a spouse typically is limited to the pendency of the divorce and terminates when the parties are no longer “spouses.”

Because a spouse and the parties' children may be covered by the other party's health insurance, there are inherent logistical issues resulting from the fact that a spouse or parent may need access to information related to his or her own insurance benefits or the benefits of his or her children. Such issues may arise where that information is held by an insurance company that only recognizes the other party as the policy holder. In the custody context, where both parents share legal custody of the children, including decision-making authority related to medical issues, it is essential that both parents have equal access to information
related to the children's medical insurance coverage or information as to prescription drug use that could be obtained from the insurance company. Even if parents do not share legal custody, but the parent without legal custody still has periods of physical custody, it is still essential that that parent have access to information as to the child's medical insurance, regardless of whether he or she is able to make decisions as to the medical care.

Domestic Relations Codes

For a spouse whose medical coverage is held by the other spouse, the issue is as simple as the need for an adult to have access to information as to his or her own medical coverage and benefits.

To address the need for the insured spouse or a parent to have access to information related to their insurance benefits or their children's insurance benefits, many jurisdictions have created statutory obligations within their domestic relations codes requiring insurance companies to provide information and access to the spouse or parent, including claims information, explanations of benefits, benefit booklets and insurance contracts. Such statutes similarly instruct insurance companies to allow the spouse or parent to submit claims for covered services without going through the policy holder.

Qualified Medical Support Orders

To ensure that insurance companies are aware of their obligation to the non-policy holding spouse or parent, an increasing number of parties are entering into Stipulations for Qualified Medical Support Orders (QMSOs), in which the parties specifically set forth what information the non-policy holder (often referred to in the QMSO as the “alternate recipient” as opposed to the “participant”) is entitled to receive from the insurance company and how claims and reimbursements are to be handled. Such QMSOs make it clear to the insurance company that the alternate recipient is to receive information as to only himself or herself and the children, and not information related to the policy holder. Conversely, the OMSO will direct the insurance company not to allow the policy holder to have access to the alternate recipient's information. In other words, a QSMO puts the insurance company on notice that the benefit recipients are not functioning as an intact family that might otherwise share information.

A QMSO also may specifically provide that should the participant change employers, the obligations and rights set forth in the QMSO will apply to the subsequent employer's insurance company without the need to modify the underlying support order.

Whether or not to enter into a QMSO depends upon the facts of a particular case, since a basic support order generally includes the obligation of the insurance policy holder to maintain the coverage and many parties may be capable of cooperating in the exchange of insurance information. However, a QMSO can be an essential tool in ensuring that, where there is less cooperation, all parties have the necessary access to information without having to involve counsel in daily transactions with the insurance companies. Moreover, a QMSO may be the most effective way of alerting the insurance company to the fact that there is a court order requiring the participant to maintain coverage for the alternate recipient and the children so that the participant cannot unilaterally terminate the coverage leaving the other spouse and/or the children uninsured.

Charles J. Meyer, a shareholder with domestic relations firm Hofstein Weiner & Meyer, P.C, Philadelphia, is a fellow of the American Academy of Matrimonial Lawyers. Scott J.G. Finger is an associate with the firm. Both authors limit their practices to all facets of family law.