The FOC office is mandated to enforce court orders regarding health care issues in two ways. They are:

• Obtaining health insurance information as required by the court order, and
• Processing and collecting on health care expenses for children not covered by insurance pursuant to the order.

Health Insurance Information

All domestic relation orders are required to have a provision for health care that addresses who is responsible for providing insurance for the children. Often, the provision states that both parties are responsible as long as insurance is available to the parent at reasonable cost through his or her place of employment, or an individual policy. If insurance is being carried on the children, the FOC needs to know the name and address of the insurance carrier, the group number, and date that it became effective. This information will be entered on the computer. Without this information, there is automatic enforcement where the computer generates a National Medical Support Notice (NMSN) to the employer whenever new employment information is obtained for either parent. The employer is then required to advise the FOC if the child is enrolled in insurance, what the insurance is, or whether insurance is available. The employer is further advised to automatically enroll the child for insurance if available at a reasonable cost. To avoid the involvement of the employer, the parents must report this information directly to the FOC as well as any changes that occur in coverage.

>>Children's Health Insurance Information - The YMCA has partnered with the State of Michigan to help you access free or low cost insurance for your children, age 18 and under.

Health Care Expenses Not Covered by Insurance

The Michigan Child Support Formula addresses the shared expenses of health care costs that are not covered by insurance in the calculation of support. Most orders have a provision that identifies the share that each parent is responsible for after insurance. In addition, any order that was entered or modified after October 1, 2004 has a provision for ordinary health care expenses. Ordinary health care expenses are those expenses that are equivalent to the first $345 per calendar year per child, the aggregate total. Looking at the percentage that each parent is to pay for expenses not covered by insurance helps here because the ordinary health care expense is the first $345 per child per calendar year times the approximate percentage that the payer of support would pay and then divides it over the 12 months of the year. This is charged on the computer on a monthly basis just like child support. This means the FOC will not process any uninsured health care expenses for the payee until he or she has receipts that total the appropriate amount.

Qualified Medical Child Support Orders (QMCSO)

These are a special type of domestic relations order that requires the insurance company to communicate with both parents equally. Most insurance companies will only communicate with the policy holder (Subscriber) regarding what the policy will cover, what the co-pays are, who was sent the reimbursement check, or whether a claim has been processed. This makes it difficult for the other parent to track the insurance claim. By entering the QMCSO, the court is directing the insurance company to provide information to the non-subscribing parent about the children covered by the order currently being enforced by the FOC.

Enforcement of Heathcare FAQs

Q: The other parent is not carrying insurance. What can I do?
A: First, read your court order to make sure there is a provision requiring the other parent to provide insurance, then contact the FOC in writing requesting that this information be obtained. The FOC will then initiate enforcement of the order.

Q: We have an agreement that is different than the health care provision in our order. Should we do anything about that?
A: Yes. Even though the FOC encourages agreement and cooperation, it is important to change your order to reflect what you are doing. Simply contact the Health Care Unit and an appointment will be scheduled for both of the parents to attend a meeting. The Health Care case manager will assist you in the preparation of a stipulation and order modifying the previous court order.

Q: I think that the health care insurance offered through my employer is too expensive. Do I still have to provide it?
A: This depends on what your court order says and whether the insurance is at a “reasonable” cost. In Kent County, reasonable cost is defined as 5% of your gross income. Once you have contacted the FOC, the Health Care Unit will communicate with your employer to make the determination whether you must provide insurance or not. This information will then be shared with you.

Q: We have two children. Does that mean that there has to be $690 in total health care receipts before the FOC can be used to collect? Also, what if the receipts are all for one child, does there have to be in excess of $345 in receipts for each child?
A: After $690 of total non-reimbursed health care expense has been incurred, regardless of how much of the expense was for each child, the payee of support can seek assistance in the collection of the health care expenses according to the order as long as the procedure is followed giving the other parent 28 days to pay the payee directly. Instructions and forms are available under “Medical Payment Forms”. The payer of support can request reimbursement for health care expenses that he or she has incurred at any time up to one year after the bill was incurred. If there is an arrearage on the account, then the arrearage will be adjusted to include the reimbursement.

Q: If I have health care bills to pay through the FOC and my Income Withholding Notice is modified, does the extra money go to the service provider or to the payee of support?
A: No money is directed to the service provider. Eventually, the extra money will be paid on the medical reimbursement account to the payee, but not until all child support arrearages are paid in full. This is according to the Federal regulation for distribution of support.

Q: I prefer to pay the service provider rather than going through the FOC. Is that possible?
A: You have 28 days to work out arrangements with the payee of support before the claim can be submitted though the FOC. However, once submitted and processed through the FOC, you must pay through the FOC.

Q: What if I receive the claim from the payee of support and I have already paid the provider my share?
A: You should immediately contact the payee of support and advise because they may not be aware that you have made the payment. If you still get a request for reimbursement form from the FOC office for this service, contact the office immediately and submit proof that you have paid your share to the service provider.

Q: Will the QMCSO allow the other parent to get information about other people covered by this policy such as myself or present spouse?
A: No, this only gives access to information about the children in the case enforced by the FOC. This does not give access to insurance or health information regarding the subscriber, or other members of his or her family.

Q: Why would I want a QMCSO?
A: It may help you get explanation of benefits faster, or allow for out of pocket expense to be directly reimbursed from the insurance company. If there are multiple insurance companies, the explanation of benefits from the first company may be required before a claim to the secondary insurance company can be made (coordination of benefits).

Q: Do I have to go through the FOC to get a QMCSO?
A: No, you can have your attorney file a motion before the court, or you may elect to represent yourself in this action to secure a QMCSO.