CHILD SUPPORT GUIDELINES

CS 407P Health Insurance, Medical Expenses and Insurance Credit

07/94 Revised 04/07/17 Training Completed 05/05/17

45 CFR 303.31; U.C.A. 30-3-5, 31A-1-301(1), 62A-11-103(2), 78B-12-103, 78B-12-212; R527-201

 

 

Statutory Authority

 

Effective May 11, 2010, U.C.A. 78B-12-212 was amended and contains the following requirements and procedures regarding medical support on a Utah order.  The cost of insurance premiums is a separate “add-on” obligation and expense to be divided equally between the parents on all Utah orders with a current support obligation.  Subsections 78B-12-212 (1) through (3) contain the following requirements and procedures regarding medical support:

“(1)(a)  The court shall order that insurance for the medical expenses of the minor children be provided by a parent if it is available at a reasonable cost.

(b) The court shall, in accordance with Section 30-3-5, designate which health, hospital, or dental insurance plan is primary and which health, hospital, or dental insurance plan is secondary if at any time a dependent child is covered by both parents’ health, hospital, or dental insurance plans.”

(2) In determining which parent shall be ordered to maintain insurance for medical expenses, the court or administrative agency may consider the:
(a) reasonableness of the cost;
(b) availability of a group insurance policy;
(c) coverage of the policy; and
(d) preference of the custodial parent.
(3) The order shall require each parent to share equally the out-of-pocket costs of the premium actually paid by a parent for the children's portion of insurance unless the court finds good cause to order otherwise.” (Emphasis added.)


Subsections 78B-12-212 (4) through (6) contain the following additional requirements:

(4) The parent who provides the insurance coverage may receive credit against the base child support award or recover the other parent's share of the children's portion of the premium.  In cases in which the parent does not have insurance but another member of the parent's household provides insurance coverage for the children, the parent may receive credit against the base child support award or recover the other parent's share of the children's portion of the premium.

(5) The children's portion of the premium is a per capita share of the premium actually paid. The premium expense for the children shall be calculated by dividing the premium amount by the number of persons covered under the policy and multiplying the result by the number of children in the instant case.

(6) The order shall include a cash medical support provision that requires each parent to equally share all reasonable and necessary uninsured and unreimubrsed medical and dental expenses, including deductibles and copayments, incurred for the dependent children.”

 

U.C.A. 30-3-5(1) states:

“When a decree of divorce is rendered, the court may include in it equitable orders relating to the children, property, debts or obligations, and parties.  The court shall include the following in every decree of divorce:

(a) an order assigning responsibility for the payment of reasonable and necessary medical and dental expenses of the dependent children including responsibility for health insurance out-of-pocket expense such as co-payments, co-insurance, and deductibles;

(b) (i) if coverage is or becomes available at a reasonable cost, an order requiring the purchase and maintenance of appropriate health, hospital, and dental care insurance for the dependent children; and

(ii) a designation of which health, hospital, or dental insurance plan is primary and which health, hospital, or dental insurance plan is secondary in accordance with the provisions of Section 30-3-5.5 which will take effect if at any time a dependent child is covered by both parents’ health, hospital, or dental insurance plans;” (Emphasis added.)

 

For more information on designation of which insurance is primary, refer to CS 482P Securing a Medical Insurance Provision in the Support Order.    

 

 

Definitions

 

1.                   Accident and Health Insurance – as defined by U.C.A. 31A-1-301(1): 

“(a) . . . means insurance to provide protection against economic losses resulting from:
(i) a medical condition including:
(A) a medical care expense; or
(B) the risk of disability;
(ii) accident; or
(iii) sickness.
(b) "Accident and health insurance":
(i) includes a contract with disability contingencies including:
(A) an income replacement contract;
(B) a health care contract;
(C) an expense reimbursement contract;
(D) a credit accident and health contract;
(E) a continuing care contract; and
(F) a long-term care contract; and
(ii) may provide:
(A) hospital coverage;
(B) surgical coverage;
(C) medical coverage;
(D) loss of income coverage;
(E) prescription drug coverage;
(F) dental coverage; or                                                                                  

(G) vision coverage.
(c) "Accident and health insurance" does not include workers' compensation insurance.”

 

2.                   Cash Medical Support as defined by U.C.A. 62A-11-103(2) and U.C.A. 78B-12-102(6):

a.                   U.C.A. 62A-11-103(2) requires ". . . an obligation to equally share all reasonable and necessary medical and dental expenses of children.”

b.                  U.C.A. 78B-12-212(6) requires that child support orders include a cash medical support provision  in accordance with Subsection 30-3-5(1)(b) :

“. . . each parent to equally share all reasonable and necessary uninsured and unreimbursed medical and dental expenses incurred for the dependent children, including but not limited to deductibles and copayments. . .”

 

3.                   Insurance Credit – Pursuant to U.C.A. 78B-12-212(3) each parent will share equally in the out-of-pocket costs of the insurance premium actually paid by the parent providing insurance for the child(ren)'s portion of the insurance.  For example, if the non-custodial parent (NCP) provides the insurance for his children, he or she is entitled to an insurance credit, which is then deducted from the monthly child support amount.  If the custodial parent (CP) receives the insurance credit, the amount is added to the monthly child support amount. 

 

The insurance credit amount equals 50% of the child(ren)’s portion of the monthly cost for the insurance.   

                                                                                                                                           

                EXAMPLE 1:

                NCP is ordered to pay $350.00 monthly child support for one (1) child.

§     The NCP pays $198.00 per month for insurance.

Ø    Three people are covered on the policy: the NCP, his spouse and one (1)             child.    

Ø    $198.00 divided by 3 (# of people covered on the policy) = $66.00 per     person.

Ø    $66.00 X one (1) child = $66.00.

Ø    $66.00 X 50% = $33.00 insurance credit

§     The NCP’s insurance credit is deducted from the monthly child support amount.

Ø    $350.00 - $33.00 = $317.00

 

EXAMPLE 2:

NCP is ordered to pay $350.00 monthly child support for one (1) child.

§     The CP pays $198.00 per month for insurance.

Ø    Three people are covered on the policy: the CP, her spouse and one (1) child.   

Ø    $198.00 divided by 3 (# of people covered on the policy) = $66.00 per person.

Ø    $66.00 X one (1) child = $66.00.

Ø    $66.00 X 50% = $33.00 insurance credit

§     The CP’s insurance credit is added to the monthly child support amount.

$350.00 + $33.00 = $383.00

 

4.                   Net Out-of-Pocket Cost – As defined by Office of Recovery Services/Child Support Services (ORS/CSS) for purposes of calculating reasonable cost:  The total cost a non-custodial parent/custodial parent (NCP/CP) pays each month toward a group health insurance plan which includes coverage for the dependent child(ren).

 

5.                   Reasonable Cost – As defined by 45 CFR 303.31(a)(3) and the Office of Recovery Services (ORS) Administrative Rule R527-201 Medical Support Services:

 

45 CFR 303.31(a)(3), “Cash medical support or the cost of health insurance is considered reasonable in cost if the cost to the parent responsible for providing medical support does not exceed five percent of his or her gross income or, at State option, a reasonable alternative income-based numeric standard defined in State law, regulations or court rule having the force of law or State child support guidelines adopted in accordance with § 302.56(c) of this chapter.” (Emphasis added.)

 

R527-201-7.  Reasonable Cost of Insurance Premiums, “Employment-related or other group coverage that does not exceed 5% of the obligated parent's monthly gross income is generally considered reasonable in cost. . .” 

 

This means that the net out-of-pocket cost the NCP/CP is required to pay toward the monthly premium to enroll the child(ren) in a group health insurance plan must not exceed 5% of the NCP/CP’s gross monthly income. 

 

 

Parent to Provide Notification - Insurance Credit

 

Subsections 78B-12-212 (7) through (9) contain the following requirements for notification of insurance coverage and procedures for insurance credit:

(7) The parent ordered to maintain insurance shall provide verification of coverage to the other parent, or to the Office of Recovery Services under Title IV of the Social Security Act, 42 U.S.C. Section 601 et seq., upon initial enrollment of the dependent children, and thereafter on or before January 2 of each calendar year. The parent shall notify the other parent, or the Office of Recovery Services under Title IV of the Social Security Act, 42 U.S.C. Section 601 et seq., of any change of insurance carrier, premium, or benefits within 30 calendar days of the date he first knew or should have known of the change.
(8) A parent who incurs medical expenses shall provide written verification of the cost and payment of medical expenses to the other parent within 30 days of payment.

(9) In addition to any other sanctions provided by the court, a parent incurring medical expenses may be denied the right to receive credit for the expenses or to recover the other parent's share of the expenses if that parent fails to comply with Subsections (7) and (8).”  (Emphasis added.)

 

Always calculate and give an insurance credit prospectively (do not give credit for past months) from the first day of the month following the date CSS receives both:

 

1.                   A request for an insurance credit.  Either parent (or both) may request an insurance credit.  If a parent calls and requests an insurance credit, send the Insurance Premium Credit Request letter to the parent.  The Insurance Premium Credit Request letter is case specific, which means if the parent wants credit on all of his/her cases, s/he must complete one form for each case.  If the parent has multiple cases and wants credit on all of his/her cases, you must send an Insurance Premium Credit Request letter to the parent for each case.

 

2.                   The information necessary to calculate the insurance credit.

a.                    Receipt of the completed Insurance Premium Credit Request form along with the following supporting documentation:

i.                      Proof of insurance including the name of the insurance company, verification of the policy number and the names of all individuals  covered on the policy, and;

ii.                    Proof of the insurance premium amounts paid.  This is the amount the requesting parent pays (out-of-pocket cost) each month for insurance.  This may be verified by providing:

A.                  A copy of his/her  paycheck stub showing the insurance premium deduction; or,

B.                  A statement from the employer. 

 

NOTE:  A completed Insurance Premium Credit Request letter with supporting documentation is required for the initial insurance credit and whenever there is any change to the insurance credit; e.g., a change in the coverage information or a change in the premium amounts paid, or both.

 

The requesting parent must complete one (1) Insurance Premium Credit Request form for each case s/he is requesting insurance credit on, attach proof of insurance (verification of the policy number and a list of all individuals covered on the policy), proof of the insurance premium paid by the employee/individual purchasing the insurance (e.g. a copy of a paycheck stub or statement from the employer), and mail or fax the letter and the supporting documentation to ORS/CSS.

Give the parent credit from the first day of the month following the date the completed Insurance Premium Credit Request form and all required documentation is received in the office.  Do not give credit retroactively (apply to a prior period of time) unless one of the exceptions below applies.  A retroactive insurance credit based on one of the exceptions listed below may only be granted by obtaining approval through the appropriate team manager.

EXCEPTION 1:  On a new case, an insurance credit may be given retroactive to the date of the application for child support services if:

 

1.                   Either parent requests a retroactive insurance credit and returns the Insurance Premium Credit Request form with all required documentation within 60 days of the Initial Contact Letter to NCP, or on a new case which includes a judicial determination of arrears, within 60 days of the Annual Notice of Past-Due Child Support; and,

 

2.                   The requesting parent has proof of prior notice to the other parent pursuant to U.C.A. 78B-12-212(7), or the other parent confirms knowledge of the insurance for the dates requested, or CSS can draw the conclusion that the other parent knew about the insurance, because s/he used the insurance on behalf of the child(ren); and,

 

3.                   The request has been approved through the appropriate team manager.

 

EXAMPLE:

§     Facts:

Ø    The CP applies for CSS services with an application dated April 13, 2016.

Ø    The ordered monthly child support amount is added to ORSIS on April 20, 2016 and is effective the month of the application, April 2016.

Ø    An Initial Contact Letter to NCP dated April 22, 2016 is mailed to the NCP.

Ø    On June 10, 2016 (50 days from the date of the R01A), the NCP requests an insurance credit and wants it applied retroactively claiming that the CP knew about the insurance since January 2016.  The NCP is given an Insurance Premium Request form to complete and return along with the supporting documentation.

Ø    The completed form and required supporting documentation is returned on June 17, 2016.

Ø    The agent assigned to the case is able to verify that the CP did in fact know about the insurance and began using it in January 2016. 

§     Outcome:

Ø    Because the NCP requested the insurance credit within 60 days of being sent the Initial Contact letter, and with manager approval an exception is granted, a retroactive insurance credit is given effective April 2016.  This is the month the CP applied for services and the monthly current support amount was added to the case. 

Ø    A retroactive insurance credit cannot be given for the time period prior to the date of the application for services (i.e., January through March 2016).  Because ORS did not have a case open during this time period, the arrears debt for this timeframe, including any applicable insurance credits, must be adjudicated. 

Ø     

EXCEPTION 2:  An extenuating circumstance prevents the party from requesting an insurance credit, receiving the form and/or returning the form to ORS.  Each case with an extenuating circumstance must be reviewed with the appropriate team manager PRIOR to granting retroactive credit.

 

 

Accident Insurance Credit Request

 

If the NCP/CP request an insurance credit for providing “accident” insurance on his/her child(ren), complete the following:

 

1.                   Send the Insurance Premium Request form to the parent.

 

2.                   Request a benefit summary.  Have the NCP/CP provide CSS with a benefit summary, which should show:

a.                   If the child(ren) are covered on the accident insurance plan; and,

b.                  If the plan provides for a health care contract, which includes:

i.                     Hospital coverage;

ii.                   Surgical coverage;

iii.                  Medical coverage;

iv.                 Prescription drug coverage;

v.                   Dental coverage; or

vi.                 Vision coverage.

 

3.                   Consult with the Attorney General’s Office (AGO), once the benefit summary has been received.  The AGO will review the benefit summary and determine if the “accident” insurance provides health insurance benefits.   

 

4.                   Take the next appropriate action – if the “accident” insurance:

a.                   Provides health insurance benefits.  Calculate and give the NCP/CP credit for the insurance.  For procedures and more information, refer to the appropriate subsections within this policy.

b.                  Does not provide health insurance benefits.  The NCP/CP will not be given credit for providing health insurance.  Continue to monitor and enforce the case for valid health insurance..

 

NOTE:  Insurance credit should only be given for premiums paid on health insurance benefits (Medical, Prescription, Dental and Vision).  Insurance credit should not be given for “accident” or “disability” insurance that does not include health insurance benefits.  If you have questions on whether or not an insurance policy provides health insurance benefits, consult with the attorney assigned to the case.

 

 

Calculating the Insurance Credit

 

Once the NCP/CP requests an insurance credit and you have received the Insurance Premium Credit Request form along with all supporting documentation, proof of coverage and proof of cost, (refer to subsection Parent to Provide Notification – Insurance Credit, above), you may calculate the credit and make the appropriate adjustments.

 

The insurance credit amount equals 50% of the child(ren)’s portion of the monthly cost for the insurance.

 

1.                   Calculate the “per capita” (per person) amount of the premium by dividing the total out-of-pocket premium (see note below) amount by the total number of people covered by the insurance.  This includes children that are not listed on the ORS case.

 

NOTE:  The total out of pocket premium includes the total cost a NCP/CP pays each month to enroll himself/herself, (include the entire amount paid for the NCP/CP even if it is higher because of a medical condition) and all the child(ren) covered in a group health insurance plan.   For more information on the definition of out-of-pocket premium, refer to subsection Definitions, above.

 

2.                   Multiply the “per capita” amount by the number of child(ren) on the ORS case.  The result equals the “child(ren)’s portion” of the premium.

 

3.                   Either divide the child(ren)’s portion of the premium by 2 or multiply it by 50% (.50) to obtain the amount of the insurance credit to be applied in the case. 

 

EXAMPLE:

§     Facts:

Ø    Total out-of-pocket premium each month is $153.98;

Ø    Five people are covered on the policy:

·                     NCP and present spouse;

·                     Present spouse’s child; and the,

Ø    Two children listed on the worksheet and on the ORS case.

§     Calculations: 

Ø    $153.98 divided by 5 = $30.79 per capita amount;

Ø    $30.79 X 2 children on the case equals $61.59;

Ø    50% of the children’s portion would be $30.79.  This is calculated as follows:  $61.59 (children’s portion) divided by 2 or multiplied by 50% (.50) = $30.79 insurance credit.

NOTE 1:  Do not round the insurance credit amount up or down.  Pursuant to U.C.A. 78B-12-212(5) the insurance credit must be given based on the premium actually paid: 

“The children's portion of the premium is a per capita share of the premium actually paid. The premium expense for the children shall be calculated by dividing the premium amount by the number of persons covered under the policy and multiplying the result by the number of children in the instant case.”  (Emphasis added)

 

NOTE 2:  If a child leaves state care or custody, emancipates, or no longer resides in the home on a IV-D case, recalculate the credit for the remaining active child(ren) on the current support debt (CRS).

 

 

Both Parents Receiving an Insurance Credit

 

Either parent, or both parents, may request and receive an insurance credit.  If a parent was not ordered to maintain health insurance for the child(ren) and s/he has voluntarily obtained the coverage, calculate the insurance credit for the parent as long as you have received the Insurance Premium Credit Request form back from the parent, including all required supporting documentation necessary to calculate the insurance credit.  If both parents are receiving an insurance credit, the NCP’s insurance credit is deducted from the monthly child support amount and the CP’s insurance credit is added to the monthly child support amount. The credits off-set and the final credit is the net amount of both credits.  

 

                EXAMPLE:

w     Facts:

§     Monthly child support order is $300.00.

Ø    NCP’s insurance credit is $30.79

Ø    CP’s insurance credit is  $41.27

w     Calculate net insurance credit

§     $300.00 - $30.79 (NCP’s insurance credit) = 269.21 + $41.27 (CP’s insurance credit) = $310.48 (monthly child support amount with both NCP’s and CP’s insurance credits),

§     The net insurance credit is $10.48

 

EXCEPTION:  If the parent ordered to carry insurance contests the unobligated parent’s (the parent not specifically ordered to carry insurance) credit, refer to subsection Procedures – No Insurance Provision in Order, below for more information.

 

 

Calculating the Insurance Credit on a Split Custody Order

 

If the support order is a split custody order, once you receive the Insurance Premium Credit Request form and all required documentation necessary to calculate the insurance credit, calculate the insurance credit the same way as on a sole custody order.  Make sure you include ALL of the children on the case in your calculations to determine the per capita cost, regardless of which parent they are currently residing with. For additional information, refer to subsection Calculating the Insurance Credit, above.)

 

EXAMPLE:

w     Facts:

§     The NCP and CP have six children.

Ø    The NCP has three children; and

Ø    The CP has three children (split custody).

§     The NCP pays $900.00 per month child support for the three children living with the CP; and,

§     The NCP pays $613.87 per month for insurance.

§     There are eight people covered on the policy.

Ø    NCP;

Ø    NCP’s present spouse; and

Ø    All six children.

w     Calculations:

§     Calculate the per capita amount.  $613.87 divided by 8 =$76.73.

§     Multiply the per capita amount by the number of children on the case.  $76.73 x 6 = $460.40.  This is the children’s portion of the premium.

§     Multiply the children’s portion by 50% (.50) or divide by 2.  $460.40 x .50 = $230.20.  This is the insurance credit amount.

w     Adjusted Child Support Amount:

§     $900.00 (ordered child support amount) minus $230.20 (insurance credit) = $669.80 (adjusted child support amount).

 

NOTE:  Insurance credit must be given for all six children because the statute requires that the cost of insurance for all of the children addressed by the support order (all of the children in common between the two parents identified in the order) be shared equally between the two parents.

 

Calculating Insurance Credit on CIC Cases

 

CIC has waived its right to charge the other parent for his/her share of the insurance premium; therefore, once the NCP requests an insurance credit and/or you have received the required insurance information (refer to subsection Parent to Provide Notification of Coverage – Insurance Credit, above), calculate the credit and make the appropriate adjustment.

 

EXAMPLE 1:  The parents divorced.  There are two separate cases open, and one of the parents enrolls the children in his/her insurance plan.

w     Facts:

§     Two children.  Both kids are in CIC programs.

§     CIC has two cases.  There is a child support order for $400.00 per month.

§     Case A – Father = NCP.  He:

Ø    Pays $200.00 per month child support; and,

A.                  Pays $157.89 per month for insurance; the policy covers the NCP and both children (three (3) people covered total).

§     Case B – Mother = NCP.  She:

Ø    Pays $200.00 per month child support; and,

Ø    Does not have any insurance.

w     Calculations:

§     Determine Insurance Credit:

Ø    Case A:

·                     Calculate the per capita amount ($157.89 divided by 3 = $52.63). 

·                     Multiply the per capita amount by the number of children on the case ($52.63 X 2 = $105.26).  This is the children’s portion of the premium.

·                     $105.26 multiplied by 50% (.50) or divided by 2 = $52.63 (insurance credit).

Ø    Case B:  No insurance calculation is necessary.

w     Adjusted Child Support Amount. 

§     Case A - $200.00 (Father’s share of child support order) - $52.63 (insurance credit) = $147.37.

§     Case B – Do not increase or decrease the child support amount for the NCP on CASE B who is not providing the medical insurance for the child.

 

EXAMPLE 2:  The parents are divorced.  There are two separate CIC cases open, and both parents enroll the children in insurance.

w     Facts:

§     Two children.  Both kids are in CIC programs.

§     CIC has two cases.  There is a child support order requiring that each parent pay $200 per month.

§     Case A – Father = NCP.  He pays:

Ø    $200.00 per month child support; and,

Ø    $157.89 per month for insurance; the policy covers the NCP and both children (three (3) people covered total).

§     Case B – Mom = NCP.  She pays:

Ø    $200.00 per month child support, and,

Ø    $61.14 per month for insurance the policy covers the NCP and both children (three (3) people covered total).

w     Calculations: 

§     Determine Insurance Credit:

Ø    Case A:

·                     Calculate the per capita amount ($157.89 divided by 3 = $52.63).

·                     Multiply the per capita amount by the number of children on this case ($52.63 X 2 = $105.26).  This is the children’s portion of the premium.

·                     $105.26 multiplied by 50% (.50) or divided by 2 = $52.63.

Ø    Case B: 

·                     Calculate the per capita amount ($61.14 divided by 3 = $20.38).

·                     Multiply the per capita amount by the number of children on this case ($20.38 X 2 = $40.76).  This is the children’s portion of the premium.

·                     $40.76 multiplied by 50% (.50) or divided by 2 = $20.38.

w     Adjusted Child Support Amounts:

§     Case A - $200.00 (Father’s share of child support order) - $52.63 (insurance credit) = $147.37.

§     Case B - $200.00 (Mother’s share of child support order) - $20.38 (insurance credit) = $179.62.

 

EXAMPLE 3:  The parents are married and on the same child support case.  Both parents enroll the children in insurance.   

w     Facts:

§     Two children.  Both kids are in CIC programs.

§     CIC has one case.  There is a child support order for $400.00 per month

Ø    NCP/Father – pays $163.98 per month for insurance; the policy covers both NCPs (mother and father) and both children (Four (4) people covered total).

Ø    NCP/Mom – pays $80.22 per month for insurance; the policy covers both NCPs and both children (four (4) people covered total).

w     Calculations:

§     Determine Insurance Credit:

Ø    NCP/Father:

·                     Calculate the per capita amount ($163.98 divided by 4 = $40.99).

·                     Multiply per capita amount by the number of children on this case ($40.99 X 2 = $81.98).  This is the children’s portion of the premium.

·                     $81.98 multiplied by 50% (.050) or divided by 2 = $40.99.

Ø    NCP/Mom:

·                     Calculate the per capital amount ($80.22 divided by 4 = $20.05).

·                     Multiply the per capita amount by the number of children on this case ($20.05 X 2 = $40.10).  This is the children’s portion of the premium.

·                     $40.10 multiplied by 50% (.050) or divided by 2 = $20.05.

Ø    Add both parents’ credit together:  NCP/Father $40.99 + NCP/Mother $20.05 = $61.04 (total insurance credit amount).

w     Adjusted Child Support Amount:  $400.00 (child support order) - $61.04 (total Insurance credit amount) = $338.96.

 

NOTE:  There may be circumstance in an intact family where the parents are entitled to the full credit.  If you have questions regarding an insurance credit on an intact family, consult with the AGO.

 

Procedures – Calculating the Insurance Credit on Specified Relative Cases

 

If the case is a specified relative case, and there is an open case for both parents, once you have received the required insurance information, calculate the insurance credit and apply the credit to each case as appropriate.  For additional information, refer to the example below.

 

                EXAMPLE:

§     Facts:

§     Two children.  Both kids live with their grandmother.

§     CSS has two cases.  There is a child support order requiring that the father pay $200.00 per month and the mother pay $100.00 per month.

Ø    Case A – Father = NCP, Grandmother = CP;

·                     NCP pays $200.00 per month child support; and,

·                     $157.89 per month for insurance; the policy covers the NCP and both children (3 people covered total).

Ø    Case B – Mom =  NCP, Grandmother = CP;

·                     NCP pays $100.00 per month child support; and,

·                     Carries no insurance.

§     Calculations:

§     Determine Insurance Credit.

Ø    Calculate the per capita amount ($157.89 divided by 3 = $52.63);

Ø    Multiply the per capita amount by the number of children on the case ($52.63 x 2 = $105.26).  This is the children’s portion of the premium;

Ø    $105.26 multiplied by 50% (.50) or divided by 2 = $52.63.

§     Adjusted child support amount:

§     Case A - $200.00 (Father’s child support obligation) minus $52.63 (insurance credit) = $147.37.

§     Case B - $100.00 (Mother’s child support obligation) plus $52.63 (insurance credit) = $152.63.

 

NOTE:  When giving the parent providing insurance (father) credit for his insurance premium, you must add the credit to the other parent’s (mother) portion of the child support obligation.

 

Procedures – Order Limits Credit Amount

 

The order may contain language that limits the credit, such as:  “Credit shall not exceed 50% of the NCP’s proportionate share of the base combined child support obligation.”  If the order limits the credit, allow credit up to the amount permitted by the order.  If the order does not limit the amount of the credit that can be given and the obligated parent is carrying the insurance, once you have received the required insurance information, give credit for 100% of the amount for which s/he is eligible, after applying the procedures found in subsection Calculating the Insurance Credit to determine the credit. 

 

 

Procedures – No Insurance Provision in Order

 

If a Utah order issued on or after July 1, 1994 does not have an insurance provision and the NCP or the CP voluntarily enrolls the child(ren) in an insurance plan, pursuant to U.C.A. 78B-12-212(4) the parent is entitled to an insurance credit.  Give the parent credit against the base child support award after receiving his/her request and after receipt of the Insurance Premium Credit Request form and all required documentation necessary to calculate the insurance credit. 

 

EXCEPTION:  If a parent not specifically ordered to carry insurance has the child(ren) enrolled in his/her insurance and is receiving an insurance credit, but either parent contests the credit because the order does not allow that parent credit or order that parent to carry insurance, refer the case to your manager to determine if it is still appropriate to allow the credit.  The manager (with AGO assistance) will review the order to determine if there is a provision or language in the order, separate from the provision ordering one parent to carry insurance, which allows/supports the unobligated parent receiving insurance credit despite the objections raised (i.e., a provision requiring both parents to share half of the medical expenses or other similar provision).  If there is no language which allows the credit (causing the manager to determine it is no longer appropriate to allow the unobligated parent insurance credit), the current support debt will be adjusted prospectively to remove the credit.

 

If the order is a Utah judicial order and it was issued on or after July 1, 1994 (see below), attempt to obtain an order for medical insurance by asking the parties to stipulate to an order which includes a standard “either/or” provision for insurance coverage.  Contact the AGO and have them prepare the stipulation for you.  If either party refuses to stipulate, ask your AGO to pursue an insurance order, which includes an “either/or” provision.  CIC should follow their current procedures for issuing temporary administrative insurance orders. 

 

 

Procedures – Giving the Insurance Credit

 

1.                   Utah Orders Issued on or after July 1, 1994.  After you have received a request for an insurance credit and receipt of the Insurance Premium Credit Request form along with the required documentation, calculate the insurance credit amount and give the appropriate parent credit by taking the steps listed below.

a.                   Forward the insurance credit information and calculation to the Senior Agent or CIC agent authorized to adjust the current support debt.

i.                     The Senior Agent (or authorized CIC worker) will make the appropriate adjustment to the current support debt on ORSIS.

ii.                   The effective date of the adjustment will be the first day of the month following the date the completed Insurance Premium Credit Request form and all required documentation is received in the office, unless there is an exception.  For additional information on exceptions, refer to subsection Parent to Provide Notification – Insurance Credit, above.

b.                  Update ORSIS.

c.                   Document all actions taken in the case narratives, including the parent that is receiving the insurance credit.

 

2.                   Utah Orders Issued Prior to July 1, 1994.  If the order is a pre-guideline order, consult with the AGO. 

 

NOTE:  If you are unclear on whether to allow the credit on a case, and/or if the case scenario is unusual and has not previously been addressed in this section, consult with your management chain (Manager, Associate Regional Director, Regional Director, and CSS Director) who will consult with the AGO to determine if a credit is appropriate on the case.

 

3.                   Modified Orders.

a.                   The original order is taken during a time when insurance credit is specified by law and insurance credit is NOT addressed in the order.  If that order is later modified to change only the child support amount and insurance credit is NOT addressed in the modification, apply the insurance credit laws that are in effect at the time of the modification.

b.                  The original order is taken during a time when insurance credit is specified by law and insurance credit IS addressed in the order.  If that order is later modified to change just the child support amount and insurance credit is NOT addressed in the modification, continue to enforce the provision as stated in the original order.  Issues that were addressed in the original order that are not addressed in the modification have not changed.

 

Procedures - Insurance Lapses

 

If the parent that is providing insurance no longer has insurance available and there was an insurance credit, you must:

 

1.                   Adjust the current support debt to the total amount of the support award.  The adjustment should be effective the month the policy is no longer in effect; and,

 

2.                   Notify both parents in writing of changes to the child support award by generating and sending the "Insurance Premium Credit Notification" letters.   

 

EXAMPLE:

a.                   Facts:  Insurance Lapses

i.                     NCP ordered to pay $300.00 per month child support.

ii.                   NCP has been providing insurance and has received a credit of $30.09 each month.

iii.                  The total adjusted child support amount is $269.21 per month ($300.00 (monthly child support) - $30.79 (insurance credit) = $269.21.

iv.                 On November 5th, CSS is notified that the NCP’s insurance has lapsed effective October 1st.

b.                  Calculations: 

i.                     Adjust the current support debt back to $300.00 (total support award) using retro-calculation, effective October 1st.

ii.                   Notify both parents of the changes to the child support award. 

 

NOTE:  If there is a specific insurance amount in the judicial order, check with the AGO before making adjustments to the debt and ending the insurance credit.

 

Notify Parent/Other State of Insurance Changes/Adjustments                

 

You must notify both parents and/or the other state in writing of any changes/adjustments to the base child support award for the children’s portion of the insurance premium by generating the following letters:

 

1.                   Insurance Premium Credit Notification to Obligee;

2.                   Insurance Premium Credit Notification to Obligor; or,

3.                   Insurance Premium Credit Notification to the Other State.

 

NOTE:  If the other state still has problems adjusting the base child support award to allow for an insurance credit, contact the AGO.  The AGO may contact the other state’s attorney to resolve the matter.