Health Insurance and Other Health Care Expenses
Wisconsin’s statutory provisions regarding payment of a minor child’s health care expenses, including health insurance, are found at Wis. Stats. Sec. 767.513. Under that statute, the court “shall specifically assign responsibility for and direct the manner of payment of the child’s health care expenses” any time there are children involved in a paternity or divorce case.
Health insurance for the minor child: The court must consider the availability of health insurance through a parent’s employment, and the court may require a parent to obtain employer-provided health insurance for a child. In practice, however, Wisconsin courts follow the federal rule that health insurance available through employment must be provided for a child only if the cost of the health insurance is “reasonable.” What is “reasonable” can change over time; currently employer-provided health insurance that costs less than five percent of a parent’s gross income is considered reasonable. Courts often consider the amount paid for a child’s health insurance in setting child support.
Out-of-pocket health care costs for the minor child: The court also assigns responsibility for paying the child’s health-related out-of-pocket costs. Health expenses not paid by insurance can include, for example, co-pays, deductibles, dental, chiropractic, orthodontia, optical, psychological, and psychiatric. Almost universally, courts in Wisconsin require parents to equally share these costs. However, we have seen courts order the higher-earning spouse to pay a greater proportion of these costs when there is a substantial disparity in the parents’ incomes.
Reconciliation of out-of-pocket health care costs: This division of responsibility for child-related health care costs requires that the parents keep careful records of these expenditures and then reconcile the expenditures so each is paying the correct amount. As with variable expenses, we strongly recommend that parents have a court order providing for reconciliation procedures and time limits. Reconciliation of out-of-pocket health care costs can be complicated because of the delay in determining what actually is owed. For example, there is often a delay between taking a child in for treatment, and receiving an explanation of benefits from the insurance provider. Yet it becomes difficult to review health care costs paid two or three years previously, so timely reconciliation is important. Thus we recommend orders that give parents thirty days from the date they are aware of their actual cost to request reimbursement, or the reimbursement is waived.