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FAQs Enrolling Children in Insurance

340:25-5-168 – Establishment of medical support

45 C.F.R §§ 302.56, 303.31 Guidelines and enforcing medical support for children

Below are several questions regarding enrolling children in health insurance. If you have additional questions for this area, please include the question in the Comments or Suggestions below.

Is it reasonable and necessary for an employer to enroll and disenroll again and again when the employee works seasonally or is temporary?
No, the employer is not obligated to seasonally enroll and disenroll the employee or his/her children. Employers must notify ESC/CSS that the situation would exceed the Consumer Credit Protection Act (CCPA) or reasonable cost limits (whichever applies on the case). When Child Support Services (CSS) is notified of this by the employer, the case may need to be reviewed to establish permanent cash medical support or to obtain private coverage.
What options does the employee have if he/she has to take out insurance but the company insurance is too costly?
CSS needs to review the response from the employer. There are multiple reasons for this response.

  1. If the provision in the order is for a reasonable cost limitation and the cost of the coverage for the children exceeds that amount, CSS specialists may need to perform a review of the order. CSS needs to ensure the employer is calculating the cost of the coverage appropriately. The cost of coverage for the employee or other adults is not included in the amount to be reviewed for the reasonable cost limit. Additionally, the reasonable cost limit is a numeric amount set by the court and is not calculated by the employer at the time of considering enrollment. If the order does not have a reasonable cost limit listed in it, the CCPA limits apply.
  2. Without a reasonable cost limit listed in the order, CSS staff needs to review the cost of the coverage in comparison to the CCPA limits. If those limits are exceeded, CSS may need to review the case for a modification of the child support order.
How should CSS respond to an employer who indicates an employee tells them they have private medical coverage?
Employers are required to honor the National Medical Support Notice (NMSN) regardless of whether or not the employee states he/she has private coverage. CSS staff must modify the court order for private coverage before employer covered insurance can be terminated.
The employee says that the cost of the insurance is not supposed to be more than 5% of his/her income. Is the employer supposed to calculate this amount?
No, this calculation is done by the court when the order is entered. The employer may not have access to all of the information about an individual’s income. He/she could have multiple sources of income the court must consider.
How does CSS know if the coverage is accessible to a child?
The National Medical Support Notice provides the address of the custodian and/or child. If the child is within 60 miles (one way) of the provider, the insurance is considered accessible in most cases. When an employer offers coverage only for an area where the child does not reside, the order may need to be modified for a different coverage option (e.g., private coverage, cash medical support, etc.).
When CSS is notified the coverage is NOT accessible, what should happen?
At the time of establishing an order, CSS should pursue a different option in the coverage hierarchy. These options include private coverage, alternative coverage from another policy holder and cash medical support. At the time of enforcing an order, CSS should consider modifying the child support order to pursue a different option in the coverage hierarchy listed above.
What happens if Family Violence has been indicated on the case? Does the NMSN (MED5) still go out?
Yes, the NMSN (MED5) still is issued but CSS’ address is on the document instead of the custodial person’s. The employer should contact the Employer Services Center to provide the information about the service area of the provider. The ESC will indicate whether the child is within that service area. CSS should not release the address of the children when family violence has been indicated.
Does CSS send out National Medical Support Notices (MED5 documents) on custodians? Does the employer really need to enroll the child?
Yes, there are some court orders that require the custodian to provide insurance for the child. A National Medical Support Notice (MED5C or MED5CA) is sent to the employer of the custodian when the court order requires that person to provide the insurance. OSIS must have an obligation where the MED ORD field is either C or D, the CHMU must be completed and a current, verified employer must exist on the CPEU.
What if the child is on SoonerCare? Should the child be enrolled in insurance?
Yes, the employer must comply with the National Medical Support Notice (MED5) and enroll the child. The fact the child is on SoonerCare does not require CSS to pursue cash medical support. Cash medical support is ordered when insurance is not available, not reasonable in cost or the court determines it would be in the best interest of the child (e.g., family violence has been indicated and there is a concern of disclosing the location of the children to the non-custodial parent or coverage availability is inconsistent).
When does cash medical support stop after a child has been enrolled in insurance? Should the employer stop withholding the cash medical support from the employee’s paycheck when they enroll the child?
Since the termination of cash medical support must be confirmed by a court, the cash medical support cannot be stopped automatically by the employer. The employer should notify CSS and the insurance recipient that enrollment has occurred. The termination of cash medical support process has to be completed prior to an amended Income Withholding Order (IWO) being issued. The termination must be completed and filed with the court prior to the obligation being updated and an amended IWO being issued to the employer. If you update the obligation prior to filing the documents in court, your documents will NOT print.
What if the noncustodial parent is now eligible for insurance but wants to continue paying cash medical support instead. Can we do that?
No, if the court order specifies the employee must enroll the child when insurance is available, he/she cannot choose to not enroll the child.
Is it possible to have an Income Withholding Order with cash medical support and the child is already enrolled in insurance?
It is possible for the court order to have both a fixed medical support amount and a child to be enrolled in insurance. The fixed medical support would be for a fixed recurring payment for items such as orthodontia or asthma treatments. The fixed medical support and cash medical support are added together on the IWO. CSS staff may need to review the obligation and the CSPAYI screen to ensure the amounts are listed correctly.
Should CSS send out the National Medical Support Notice (NMSN) to the employer of a step-parent?
No, the NMSN (MED5) is sent out to the employer of a non-custodial parent or a custodian. It is not sent out to the employer of a step-parent. The step-parent is not legally obligated to enroll the child in insurance. The court may recognize the step-parent is currently providing coverage in the child support order but if that coverage lapses, the parent would have the legal obligation to replace that coverage instead of the step-parent having the obligation. These cases would be coded with a MED ORD field of “K” on the obligation to indicate alternative coverage to prevent the NMSN from issuing on the case. However, if the coverage lapses, the order may need to be reviewed to determine if another type of coverage should be ordered for the child or if the premium costs should be adjusted in the child support guidelines.
Can a parent or custodian provide insurance for his/her child even if the other parent was ordered to provide insurance?
Yes. A parent or custodian may want to voluntarily provide coverage for a child without being legally obligated to do so. This is an issue in which CSS does not become involved.
If the children are enrolled in insurance, does that mean the SoonerCare case with OHCA should close?
No. The children could maintain their SoonerCare enrollment as long as they are eligible. The Oklahoma Health Care Authority (OHCA) would seek payments from the insurance company prior to paying for medical care from Medicaid funds. This is the Third Party Liability (TPL) program. CSS shares insurance coverage information with OHCA to facilitate this occurring.

If you would like more information about enrolling children in a health insurance plan, see the CS Quest article Enrolling the Child(ren) in a Health Insurance Plan.