I was divorced in 2011, then had a mediation in 2014. In the mediation in 2014, one point said the following: "HEALTH INSURANCE AND UNINSURED MEDICAL PER FINAL DECREE."
The "medical part" of the FINAL DECREE is posted below, names changed of course.
Who (Attys please) is responsible for paying the health insurance premiums for the children. Read the posting all the way please...
1. IT IS ORDERED that JANE DOE and John Doe shall each provide medical support for each child as set out in this order as child
support for as long as the Court may order JANE DOE and John Doe to provide support for the child under sections 154.001 and 154.002 of the Texas
Family Code. Beginning on the day JANE DOE and John Doe or potential obligation to support a child under sections 154.001 and 1 54.002
of the Family Code terminates, IT IS ORDERED that JANE DOE and John Doe are discharged from the obligations set forth in this medical support order
with respect to that child, except for any failure by a parent to fully comply with those obligations
before that date.
2. Definitions -
"Health Insurance" means insurance coverage that provides basic health-care services,
including usual physician services, office visits, hospitalization, and laboratory, X-ray, and emergency
services, that may be provided through a health maintenance organization or other private or public
organization, other than medical assistance under chapter 32 of the Texas Human Resources Code.
"Reasonable cost" means the total cost of health insurance coverage for all children for which
JANE DOE is responsible under a medical support order that does not exceed 9
percent of JANE DOE’S annual resources, as described by section 154.062(b) of the
Texas Family Code.
"Reasonable and necessary health-care expenses not paid by insurance and incurred by or on
behalf of a child" include, without limitation, any copayments for office visits or prescription drugs,
the yearly deductible, if any, and medical, surgical, prescription drug, mental health-care services,
dental, eye care, ophthalmological, and orthodontic charges. These reasonable and necessary health-
care expenses do not include expenses for travel to and from the health-care provider or for
a. to hand deliver the document by a person eighteen years of age or older either to the recipient or to a person who is eighteen years of age or older and permanently resides with the recipient;
b. to deliver the document to the recipient by certified mail, return receipt
requested, to the recipient's last known mailing or residence address; or
to deliver the document to the recipient at the recipient's last known mailing or
residence address using any person or entity whose principal business is that of
a courier or deliverer of papers or documents either within or outside the
3. Findings on Health Insurance Availability- Having considered the cost, accessibility, and quality of health insurance coverage available to the parties, the Court finds:
Health insurance is not available to JANE DOE OR JOHN DOE at a reasonable cost from another source, including the program under section 154.1826 of the Texas Family Code to provide health insurance in title IV-D cases.
IT IS FURTHER FOUND that the following orders regarding health-care coverage are in the
best interest of the children.
4. Provision of Health-Care Coverage -
JANE DOE and JOHN DOE are ORDERED to continue to maintain health insurance for each child who is the subject of this suit that covers basic health-care services, including usual physician services, office visits, hospitalization, laboratory, X-r ay, and emergency services.
John Doe IS ORDERED TO MAINTAIN such health insurance through Medicaid as long as he qualifies for state health insurance of the children.
Pursuant to section 154.183(c) of the Texas Family Code, the reasonable and necessary
health-care expenses of the children that are not reimbursed by health insurance are allocated as follows: JOHN DOE is ordered to pay 50 percent and JANE DOE is ordered to pay 50 percent of the unreimbursed health-care expenses if, at the time the expenses are incurred, JANE DOE is providing health insurance as ordered.
The party who incurs a health-care expense on behalf of a child is ORDERED to submit to the other party all forms, receipts, bills, statements, and explanations of benefits reflecting the uninsured portion of the health-care expenses within thirty days after he or she receives them. The non-incurring party is ORDERED to pay his or her percentage of the uninsured portion of the health-care expenses either by paying the health-care provider directly or by reimbursing the incurring party for any advance payment exceeding the incurring party's percentage of the uninsured portion of the health-care expenses within thirty days after the non-incurring party receives the forms, receipts, bills, statements, and explanations of benefits.
These provisions apply to all unreimbursed health-care expenses of any child who is the subject
of this suit that are incurred while child support is payable for that child.
5. Secondary Coverage - IT IS ORDERED that if a party provides secondary health
insurance coverage for the children, both parties shall cooperate fully with regard to the handling and
filing of claims with the insurance carrier providing the coverage in order to maximize the benefits available to the children and to ensure that the party who pays for health-care expenses for the children is reimbursed for the payment from both carriers to the fullest extent possible.
6. Compliance with Insurance Company Requirements - Each party is ORDERED to
conform to all requirements imposed by the terms and conditions of the policy of health insurance covering the children in order to assure maximum reimbursement or direct payment by the insurance company of the incurred health-care expense, including but not limited to requirements for advance
notice to any carrier, second opinions, and the like. Each party is ORDERED to attempt to use
"preferred providers," or services within the health maintenance organization, if applicable; however,
this provision shall not apply if emergency care is required. Disallowance of the bill by a health
insurer shall not excuse the obligation of either party to make payment; however, if a bill is disallowed
or the benefit reduced because of the failure of a party to follow insurance procedures or requirements,
IT IS ORDERED that the party failing to follow the insurance procedures or requirements shall be
wholly responsible for the increased portion of that bill.
7. Claims - Except as provided in this paragraph, the party who is not carrying the health
insurance policy covering the children is ORDERED to furnish to the party carrying the policy, within
fifteen days of receiving them, any and all forms, receipts, bills, and statements reflecting the health-
care expenses the party not carrying the policy incurs on behalf of the children. In accordance with
section 1204.251 and 1504.055(a) of the Texas Insurance Code, IT IS ORDERED that the party who is
not carrying the health insurance policy covering the children, at that party's option , part may file any
claims for health-care expenses directly with the insurance carrier with and from whom coverage is
provided for the benefit of the children and receive payments directly from the insurance company.
The party who is carrying the health insurance policy covering the children is ORDERED to
submit all forms required by the insurance company for payment or reimbursement of health-care
expenses incurred by either party on behalf of a child to the insurance carrier within fifteen days of that
party's receiving any form, receipt, bi11, or statement reflecting the expenses.
*************** "Who (Attys please if possible) is responsible for paying the health insurance premiums for the children?"
Edited by texasdivorceddad (10/15/17 02:26 PM)