CHILD SUPPORT GUIDELINES

CS 407P Health Insurance, Medical Expenses and Insurance Credit

07/94 Revised 09/01/25 Training Completed 09/15/25 Last Reviewed 10/01/25

45 CFR 303.31; Utah Code 26B-9-201, 26B-9-224, 31A-1-301, 81-4-406, 81-6-202, 81-6-208; R527-201

Statutory Authority

Utah Code 81-6-208 contains provisions regarding medical support in a Utah order. The cost of the child(ren)’s portion of the 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 81-6-208 (1) through (7) contain the following requirements and procedures regarding medical support:

“(1) As used in this section, ‘health insurance’ means the same as that term is defined in Section 31A-1-301.

(2) Except as provided in Subsection (4), a child support order issued or modified in this state on or after May 3, 2023, shall require compliance with the requirements described in Subsection (3) as of the effective date of the child support order.

(3) A child support order shall:

(a) require the parents provide health care coverage for the medical expenses of a child;

(b) require the parents provide health insurance for the medical expenses of a child if health insurance is available to the parents at a reasonable cost;

(c) designate which health insurance plan is primary and which health insurance plan is secondary if, at any time, a child is covered by both parents' health insurance plans as described in Subsection (7);

(d) require each parent to share equally the out-of-pocket costs of the premium actually paid by a parent for the child’s portion of health insurance; and

(e) include a provision that requires each parent to equally share all reasonable and necessary uninsured and unreimbursed medical and dental expenses incurred for a child, including co-payments, co-insurance, and deductibles.

(4) The court may deviate from the requirements described in Subsection (3) if:

(a) the court makes specific findings establishing good cause for the deviation; or

(b) subject to the court’s approval, the parents agree which parent shall provide health insurance for the child.

(5) In determining whether to take the action described in Subsection (4), the court may consider:

(a) the reasonableness of the cost;

(b) the availability of a group insurance policy;

(c) the coverage of the policy; or

(d) the preference of the custodial parent.

(6) Subject to Subsection (4), if a child support order does not contain the requirements described in Subsection (3):

(a) the parents are nonetheless subject to the requirements described in Subsection (3), as applicable; and

(b) for the purposes of Subsection (3)(c), the health insurance plan of the parent whose birthday falls first in the calendar year is primary, and the health insurance plan of the parent whose birthday falls second in the calendar year is secondary.

(7) (a) The provisions of an order under Subsection (3)(c) shall:

(i) take effect if at any time a child is covered by both parents' health insurance plans; and

(ii) include the following language: ‘If, at any point in time, a child is covered by the

health insurance plans of both parents, the health insurance plan of (Parent's Name) shall be primary coverage for the child and the health insurance plan of (Other Parent's Name) shall be secondary coverage for the child. If a parent remarries and the child is not covered by that parent's health insurance plan but is covered by a step-parent's plan, the health insurance plan of the step-parent shall be treated as if it is the plan of the remarried parent and shall retain the same designation as the primary or secondary plan of the child.’

(b) A court or administrative agency may not modify the language required by

Subsection (7)(a)(ii).

(c) Notwithstanding Subsection (7)(b), the court may allocate the payment of medical expenses including co-payments, deductibles, and co-insurance not covered by health insurance between the parents.

(d) In designating primary coverage pursuant to Subsection (3)(c), the court may take into account:

(i) the birth dates of the parents;

(ii) a requirement in a court order, if any, for one of the parents to maintain health insurance coverage for a child;

(iii) the parent with physical custody of the child; or

(iv) any other factor the court considers relevant.” (Emphasis added.)

For Utah orders issued or modified on or after May 3, 2023, a medical support provision is included in the order by operation of law, even if language constituting a medical support provision is absent from the order.

Subsections 81-6-208 (8) through (11) contain the following additional requirements:

“(8) (a) The parent who provides health insurance may receive credit against the base child support award or recover the other parent’s share of the child’s portion of the premium.

(b) If the parent does not have health insurance but another member of the parent’s household provides health insurance for the child, the parent may receive credit against the base child support award or recover the other parent's share of the child's portion of the premium.

(9) (a) The child's portion of the premium is a per capita share of the premium actually paid.

(b) The premium expense for a child 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.

(10) (a) The parent maintaining health care coverage or insurance shall provide verification of coverage to the other parent, or to the office under Title IV of the Social Security Act, 42 U.S.C. Sec. 601 et seq., upon initial enrollment of the child, and after initial enrollment on or before January 2 of each calendar year.

(b) The parent shall notify the other parent, or the office under Title IV of the Social Security Act, 42 U.S.C. Sec. 601 et seq., of any change of insurance carrier, premium, or benefits within 30 calendar days of the date the parent first knew or should have known of the change.

(c) 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.

(d) The court may deny a parent incurring medical expenses 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 this Subsection (10).

(11) (a) The court or administrative agency may issue an order determining the amount of a parent's liability for medical expenses of a child when the parent:

(i) is required by a prior court or administrative order to:

(A) share those expenses with the other parent of the child; or

(B) obtain insurance for medical expenses but fails to do so; or

(ii) receives direct payment from an insurer under insurance coverage obtained after the prior court or administrative order was issued.

(b) If the prior court or administrative order does not specify what proportions of the expenses are to be shared:

(i) the court may determine the amount of liability as may be reasonable and necessary; and

(ii) the administrative agency may determine the amount of liability in accordance with established rules.

(c) This Subsection (11) applies to an order without regard to when the order was issued.”

Utah Code 81-4-406 states:

“(3) In a decree of divorce, the court shall: . . .

(e) if the parties have a child as defined in Section 81-6-101, include:

(i) an order for child support and medical expenses as described in Chapter 6, Child Support. . . .”

Utah Code 81-6-202 states:

“(10) The court shall include the following provisions in a child support order: . . .

(b) a provision assigning responsibility for the payment of reasonable and necessary medical expenses for the child as described in Section 81-6-208;

(c) a provision requiring the purchase and maintenance of appropriate health care insurance for the medical expenses of the child as described in Section 81-6-208 if health care insurance is or becomes available at a reasonable cost . . .

(11) The office shall include the provisions described in Section 26B-9-224 in a child support order.”

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 Utah Code 31A-1-301:

“(1)(a) ‘Accident and health insurance’ 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) a fixed indemnity 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 – Pursuant to Utah Code 26B-9-201(5) “‘Cash medical support’ means an obligation to equally share all reasonable and necessary medical and dental expenses of children.”

Utah Code 26B-9-224(2) requires that child support orders shall include:

“(a) a provision assigning responsibility for cash medical support;

(b) a provision requiring the purchase and maintenance of appropriate health insurance for the child, if:

(i) insurance coverage is or becomes available at a reasonable cost; and

(ii) the insurance coverage is accessible to the child; and

(c) a designation of which health insurance plan is primary and which is secondary in accordance with the provisions of Section 81-6-208, which will take effect if at any time the child is covered by both parents’ health insurance plans.”

Utah Code 81-6-208(3) requires that child support orders include:

“(e) include a provision that requires each parent to equally share all reasonable and necessary uninsured and unreimbursed medical and dental expenses incurred for a child, including co-payments, co-insurance, and deductibles.”

3. Insurance Credit – Utah Code 81-6-208 provides:

“(3) A child support order shall: . . .

(d) require each parent to share equally in the out-of-pocket costs of the premium actually paid by a parent for the child's portion of the health insurance. . . .”

For example, if the noncustodial parent (NCP) provides the insurance for his/her 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.

Ø $350.00 + $33.00 = $383.00

2.

3.

4. Net Out-of-Pocket Cost – The total cost a noncustodial parent/custodial parent (NCP/CP) pays each month toward a group health insurance plan which includes coverage for the child(ren).

5. Reasonable Cost – As defined by 45 CFR 303.31(a)(3) and the Office of Recovery Services (ORS) Utah Admin. Code 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.)

R527-201-6. Reasonable Cost of Insurance Premiums, “(1) Employment related or other health insurance coverage that does not exceed 5% of the 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 for a group health insurance plan which includes coverage for the dependent child(ren) must not exceed 5% of the NCP/CP’s gross monthly income. For procedures and more information on reasonable cost, refer to CS 490P Enforcement of Medical Support and CS 494P Contesting a National Medical Support Notice.

Forms Overview

1. Insurance Premium Credit Notification to Obligee. Send this letter to the CP to notify him/her of any changes/adjustments to the base child support award for the child(ren)’s portion of the insurance premium.

2. Insurance Premium Credit Notification to Obligor. Send this letter to the NCP to notify him/her of any changes/adjustments to the base child support award for the child(ren)’s portion of the insurance premium.

3. Insurance Premium Credit Request/Verification. Send this letter to the parent requesting or receiving an insurance credit. The requesting parent must complete the enclosed form, attach proof of the insurance premium paid by the employee/individual purchasing the insurance and a list of all individuals covered on the policy, and return the documents to the Office of Recovery Services/Child Support Services (ORS/CSS) before an insurance credit will be given.

Parent to Provide Notification – Insurance Credit

Subsection 81-6-208 (10) through (11) contain the following requirement for notification of insurance coverage and procedures for insurance credit:

“(10)(a) The parent maintaining health care coverage or insurance shall provide verification of coverage to the other parent, or to the office under Title IV of the Social Security Act, 42 U.S.C. Sec. 601 et seq., upon initial enrollment of the child, and after initial enrollment on or before January 2 of each calendar year.

(b) The parent shall notify the other parent, or the office under Title IV of the Social Security Act, 42 U.S.C. Sec. 601 et seq., of any change of insurance carrier, premium, or benefits within 30 calendar days of the date the parent first knew or should have known of the change.

(c) 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.

(d) The court may deny a parent incurring medical expenses 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 this Subsection (10).

(11) (a) The court or administrative agency may issue an order determining the amount of a parent's liability for medical expenses of a child when the parent:

(i) is required by a prior court or administrative order to:

(A) share those expenses with the other parent of the child; or

(B) obtain insurance for medical expenses but fails to do so; or

(ii) receives direct payment from an insurer under insurance coverage obtained after the prior court or administrative order was issued.

(b) If the prior court or administrative order does not specify what proportions of the expenses are to be shared:

(i) the court may determine the amount of liability as may be reasonable and necessary; and

(ii) the administrative agency may determine the amount of liability in accordance with established rules.

(c) This Subsection (11) applies to an order without regard to when the order was issued.” (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/Verification letter to the parent. The Insurance Premium Credit Request/Verification 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/Verification 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/Verification 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/Verification 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/Verification 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 return the letter and the supporting documentation to ORS/CSS.

When applying the insurance credit, give the parent credit from the first day of the month following the date the completed Insurance Premium Credit Request/Verification 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/Verification 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 Utah Code 81-6-208(10), 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 for dated April 22, 2016 is mailed to the NCP.

Ø On June 10, 2016 (50 days from the date of the letter), the NCP requests an insurance credit and wants it applied retroactively. The NCP is given an “Insurance Premium Credit Request/Verification” form to complete and return along with the supporting documentation.

Ø The completed “Insurance Premium Credit Request/Verification” and required supporting documentation is returned on June 17, 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. For additional information on this topic, refer to CS 710P Limitation on the Collection of Arrears.

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 assigned Assistant Attorney General (AAG), once the benefit summary has been received. The assigned AAG 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 AAG 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/Verification 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 Utah Code 81-6-208 the insurance credit must be given based on the premium actually paid:

“(9) (a) The child's portion of the premium is a per capita share of the premium actually paid.

(b) The premium expense for a child 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.

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/Verification 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/Verification 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 – Insurance Credit, above), calculate the credit and make the appropriate adjustment.

NOTE: If there is a current insurance credit on a CSS case and a child is placed in the care or custody of the state (creating a CIC case), the insurance credit can be applied to the CIC case.

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 requiring that each parent pay $200.00 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.

Procedures – Calculating the Insurance Credit on Specified Relative Cases

Pursuant to Utah Code 81-6-208, only a parent (or a member of the parent’s household) may receive an insurance credit. Unless a specified relative has an order allowing the specified relative an insurance credit, the specified relative is not entitled to an insurance credit. 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 from either parent (refer to subsection Parent to Provide Notification – Insurance Credit above), calculate the insurance credit and apply the credit to each case as appropriate. For additional information, refer to the example below.

NOTE: On a specified relative case where there is an open case for both parents, when giving the parent providing insurance credit for his/her insurance premium, you must add the credit to the other parent’s portion of the child support obligation.

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:

§ Since each parent is responsible for half of the child(ren)’s insurance premiums, adjustments are made to both cases.

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

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

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 but before May 3, 2023 does not have an insurance provision and the NCP or the CP voluntarily enrolls the child(ren) in an insurance plan, pursuant to Utah Code 81-6-208(8) the parent may receive 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/Verification form and all required documentation necessary to calculate the insurance credit. For additional information on what information is required prior to calculating an insurance credit, refer to subsection Parent to Provide Notification – Insurance Credit, above.

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 AAG 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 assigned AAG to pursue an insurance order, which includes an “either/or” provision. CIC should follow their current procedures for issuing temporary administrative insurance orders.

NOTE: If the order is a Utah order that was issued or modified on or after May 3, 2023, a medical support provision is included in the order by operation of law, even if language constituting a medical support provision is absent from the order.

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/Verification 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/Verification 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.

1.

a.

b.

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

1.

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 assigned AAG to determine if a credit is appropriate on the case.

2. 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.

Ongoing Yearly Verification of Insurance Credits

Utah Code 81-6-208 contains the following requirements for notification of insurance coverage and procedures for insurance credit:

“(10) (a) The parent maintaining health care coverage or insurance shall provide verification of coverage to the other parent, or to the office under Title IV of the Social Security Act, 42 U.S.C. Sec 601 et seq., upon initial enrollment of the child, and after initial enrollment on or before January 2 of each calendar year.

(b) The parent shall notify the other parent, or the office 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 the parent first knew or should have known of the change.

(c) 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.

(d) The court may deny a parent incurring medical expenses 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 this Subsection (10).”

R527-201-7 states:

“(4) The health insurance credit will end on January 2 of each calendar year, in accordance with Subsection 81-6-208(10), unless the obligated parent provides verification of health insurance coverage and costs to ORS on an updated Insurance Premium Credit Request/Verification. To allow sufficient time for ORS to process the annual health insurance verification, the obligated parent may provide verification of the health insurance coverage as early as November 1 of the previous year.”

If a parent, either NCP or CP, is receiving an insurance credit, verification of coverage must be provided to ORS every year. If verification of coverage is not provided on or before January 2^nd each year, the insurance credit will be ended. An Insurance Credit Yearly Verification Report QMF will be available annually beginning November 1^st. The report is broken down by team and caseworker. All cases with an amount greater than zero in the appropriate Insurance Credit fields and is charging current support will be listed on the report.

Work the Insurance Credit Yearly Verification Report QMF beginning November 1^st each year.

Send the Insurance Premium Credit Request/Verification to the parent or parents receiving the insurance credit for each case listed on the report by November 10^th of each year and set a self-alert for January 5th of the following year to follow up on each case for which the form was sent.

1. Verification received: If a completed Insurance Policy Premium Credit Request/Verification is received on or before January 2nd of the following year, and the form includes proof of the insurance premium amounts and verification of coverage documenting all individuals covered under the policy, update ORISIS as appropriate.

NOTE: If verification was provided to ORS within 30 days prior to the date the letter was sent, ORS can use the previous information provided.

2. Verification not received: If a completed Insurance Policy Premium Credit Request/Verification form, including proof of the insurance premium amounts and verification of coverage documenting all individuals covered under the policy, is not received on or before January 2nd of the following year, update ORISIS as appropriate.

NOTE 1: When an insurance premium credit is terminated, a new Insurance Premium Credit Request/Verification form with proof of the insurance premium amounts and verification of coverage documenting all individuals covered under the policy would be required to reinstate an insurance credit.

NOTE 2: As a reminder, all insurance premium credits are effective on the first day of the month following the date CSS receives the completed Insurance Premium Credit Request/Verification form with supporting documentation, unless it meets one of the exceptions above.

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.

2. Update ORSIS appropriately.

3. Document all actions taken on the case, in the case narratives.

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

EXAMPLE:

§ Facts: Insurance Lapses

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

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

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

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

§ Calculations:

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

Ø Agent updates fields on the 324/333 screen as follows:

· INS CREDIT AMT to $0.00.

· INS CREDIT DATE to 10/1/2015. This is the date the insurance lapsed.

Ø Notify both parents of the changes to the child support award by sending the:

· “Insurance Premium Credit Notification to Obligee” letter to the CP; and

· “Insurance Premium Credit Notification to Obligor” letter to the NCP.

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:

· Insurance Premium Credit Notification to Obligee;

· Insurance Premium Credit Notification to Obligor; or,

· 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.