During a marriage, it is common for one party to provide health insurance for the whole family. For instance, my wife works for a school district. Therefore, she is able to provide health insurance for our children and me through her work policy.
In a divorce situation, courts strive to preserve the status quo during the marriage. Accordingly, prior to the divorce being finalized, the party that has always provided health insurance should continue to do so.
Likewise, if there are any out-of-pocket expenses they should be paid in a manner consistent with any pendente lite support orders (court orders in place during pendency of divorce proceedings).
What About After a Divorce is Finalized?
In New Jersey the Divorce Agreement should set forth all of the obligations between the parties. This would include the treatment of unreimbursed medical expenses (i.e. out-of-pocket medical expenses) as well as requirements to maintain health insurance coverage.
Health Insurance Coverage for a Spouse
A quick note regarding health insurance and spouses. Regarding spouses, the obligation to maintain health insurance generally ends the day the divorce is finalized. Even if you wished to maintain your spouse on your policy, most workplace or other health insurance policies would foreclose your doing so. The most one can do is offer the other spouse COBRA insurance, generally to be paid to the spouse who lacks health insurance. The COBRA insurance can generally last up to 18 months. Accordingly, the finalizing of a divorce generally requires both parties to, moving forward, maintain their own health insurance policies.
Health Insurance Coverage for Children
The divorce agreement should set forth which parent will maintain health insurance for the children. Any out-of-pocket costs a parent pays towards a child/children should also be considered when calculating child support. The agreement may set forth alternative future considerations, setting forth, for instance, what would occur if a party were to lose their access to health insurance. If neither party has health insurance then the agreement may set forth the actions to be taken to obtain health insurance and the division of any costs, as applicable.
Unreimbursed Medical Expenses for Children
The divorce agreement should also set forth how unreimbursed medical expenses will be handled. Under general New Jersey law, the parent of primary residence is responsible for the first $250.00 each year (per child) and the parties thereafter will divide any additional out-of-pocket costs (such as co-pays, braces, dental work, or other out-of-network or out-of-pocket expenses).
The parties may agree to divide the costs (beyond the first $250.00 each year, per child) evenly (50%-50%) or they may agree to divide them in a proportionate manner (in accordance with their income). The parties may also include language in the divorce agreement addressing additional details, such as stating that both parties will endeavor to stay in-network absent an emergency, that the parties will keep the other party informed and advised, that proof of out-of-pocket expenses will be shown in a timely fashion, etc., (these are just examples as the parties can within reason include any additional language they wish).
Partner with Carl Taylor, Esq.
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