2006 Minnesota Statutes

518A.41 MEDICAL SUPPORT.
    Subdivision 1. Definitions. The definitions in this subdivision apply to this chapter and
chapter 518.
    (a) "Health care coverage" means health care benefits that are provided by a health plan.
Health care coverage does not include any form of medical assistance under chapter 256B or
MinnesotaCare under chapter 256L.
    (b) "Health carrier" means a carrier as defined in sections 62A.011, subdivision 2, and
62L.02, subdivision 16.
    (c) "Health plan" means a plan meeting the definition under section 62A.011, subdivision 3,
a group health plan governed under the federal Employee Retirement Income Security Act of
1974 (ERISA), a self-insured plan under sections 43A.23 to 43A.317 and 471.617, or a policy,
contract, or certificate issued by a community-integrated service network licensed under chapter
62N. Health plan includes plans:
    (1) provided on an individual and group basis;
    (2) provided by an employer or union;
    (3) purchased in the private market; and
    (4) available to a person eligible to carry insurance for the joint child.
Health plan includes a plan providing for dependent-only dental or vision coverage and a plan
provided through a party's spouse or parent.
    (d) "Medical support" means providing health care coverage for a joint child by carrying
health care coverage for the joint child or by contributing to the cost of health care coverage, public
coverage, unreimbursed medical expenses, and uninsured medical expenses of the joint child.
    (e) "National medical support notice" means an administrative notice issued by the public
authority to enforce health insurance provisions of a support order in accordance with Code of
Federal Regulations, title 45, section 303.32, in cases where the public authority provides support
enforcement services.
    (f) "Public coverage" means health care benefits provided by any form of medical assistance
under chapter 256B or MinnesotaCare under chapter 256L.
    (g) "Uninsured medical expenses" means a joint child's reasonable and necessary
health-related expenses if the joint child is not covered by a health plan or public coverage when
the expenses are incurred.
    (h) "Unreimbursed medical expenses" means a joint child's reasonable and necessary
health-related expenses if a joint child is covered by a health plan or public coverage and the plan
or coverage does not pay for the total cost of the expenses when the expenses are incurred.
Unreimbursed medical expenses do not include the cost of premiums. Unreimbursed medical
expenses include, but are not limited to, deductibles, co-payments, and expenses for orthodontia,
and prescription eyeglasses and contact lenses, but not over-the-counter medications if coverage
is under a health plan.
    Subd. 2. Order. (a) A completed national medical support notice issued by the public
authority or a court order that complies with this section is a qualified medical child support order
under the federal Employee Retirement Income Security Act of 1974 (ERISA), United States
Code, title 29, section 1169(a).
    (b) Every order addressing child support must state:
    (1) the names, last known addresses, and Social Security numbers of the parents and the
joint child that is a subject of the order unless the court prohibits the inclusion of an address or
Social Security number and orders the parents to provide the address and Social Security number
to the administrator of the health plan;
    (2) whether appropriate health care coverage for the joint child is available and, if so, state:
    (i) which parent must carry health care coverage;
    (ii) the cost of premiums and how the cost is allocated between the parents;
    (iii) how unreimbursed expenses will be allocated and collected by the parents; and
    (iv) the circumstances, if any, under which the obligation to provide health care coverage
for the joint child will shift from one parent to the other; and
    (3) if appropriate health care coverage is not available for the joint child, whether a
contribution for medical support is required.
    Subd. 3. Determining appropriate health care coverage. (a) In determining whether a
parent has appropriate health care coverage for the joint child, the court must evaluate the health
plan using the following factors:
    (1) accessible coverage. Dependent health care coverage is accessible if the covered joint
child can obtain services from a health plan provider with reasonable effort by the parent with
whom the joint child resides. Health care coverage is presumed accessible if:
    (i) primary care coverage is available within 30 minutes or 30 miles of the joint child's
residence and specialty care coverage is available within 60 minutes or 60 miles of the joint
child's residence;
    (ii) the coverage is available through an employer and the employee can be expected to
remain employed for a reasonable amount of time; and
    (iii) no preexisting conditions exist to delay coverage unduly;
    (2) comprehensive coverage. Dependent health care coverage is presumed comprehensive
if it includes medical and hospital coverage and provides for preventive, emergency, acute, and
chronic care. If both parents have health care coverage that meets the minimum requirements,
the court must determine which health care coverage is more comprehensive by considering
whether the coverage includes:
    (i) basic dental coverage;
    (ii) orthodontia;
    (iii) eyeglasses;
    (iv) contact lenses;
    (v) mental health services; or
    (vi) substance abuse treatment;
    (3) affordable coverage. Dependent health care coverage is affordable if it is reasonable in
cost; and
    (4) the joint child's special medical needs, if any.
    (b) If both parents have health care coverage available for a joint child, and the court
determines under paragraph (a), clauses (1) and (2), that the available coverage is comparable
with regard to accessibility and comprehensiveness, the least costly health care coverage is the
presumed appropriate health care coverage for the joint child.
    Subd. 4. Ordering health care coverage. (a) If a joint child is presently enrolled in health
care coverage, the court must order that the parent who currently has the joint child enrolled
continue that enrollment unless the parents agree otherwise or a parent requests a change in
coverage and the court determines that other health care coverage is more appropriate.
    (b) If a joint child is not presently enrolled in health care coverage, upon motion of a parent
or the public authority, the court must determine whether one or both parents have appropriate
health care coverage for the joint child and order the parent with appropriate health care coverage
available to carry the coverage for the joint child.
    (c) If only one parent has appropriate health care coverage available, the court must order
that parent to carry the coverage for the joint child.
    (d) If both parents have appropriate health care coverage available, the court must order the
parent with whom the joint child resides to carry the coverage for the joint child, unless:
    (1) either parent expresses a preference for coverage available through the parent with
whom the joint child does not reside;
    (2) the parent with whom the joint child does not reside is already carrying dependent health
care coverage for other children and the cost of contributing to the premiums of the other parent's
coverage would cause the parent with whom the joint child does not reside extreme hardship; or
    (3) the parents agree to provide coverage and agree on the allocation of costs.
    (e) If the exception in paragraph (d), clause (1) or (2), applies, the court must determine
which parent has the most appropriate coverage available and order that parent to carry coverage
for the joint child. If the court determines under subdivision 3, paragraph (a), clauses (1) and (2),
that the parents' health care coverage for the joint child is comparable with regard to accessibility
and comprehensiveness, the court must presume that the parent with the least costly health care
coverage to carry coverage for the joint child.
    (f) If neither parent has appropriate health care coverage available, the court must order
the parents to:
    (1) contribute toward the actual health care costs of the joint children based on a pro rata
share; or
    (2) if the joint child is receiving any form of medical assistance under chapter 256B or
MinnesotaCare under chapter 256L, the parent with whom the joint child does not reside shall
contribute a monthly amount toward the actual cost of medical assistance under chapter 256B or
MinnesotaCare under chapter 256L. The amount of contribution of the noncustodial parent is the
amount the noncustodial parent would pay for the child's premiums if the noncustodial parent's
PICS income meets the eligibility requirements for public coverage. For purposes of determining
the premium amount, the noncustodial parent's household size is equal to one parent plus the
child or children who are the subject of the child support order. If the noncustodial parent's
PICS income exceeds the eligibility requirements for public coverage, the court must order
the noncustodial parent's contribution toward the full premium cost of the child's or children's
coverage. The custodial parent's obligation is determined under the requirements for public
coverage as set forth in chapter 256B or 256L. The court may order the parent with whom the
child resides to apply for public coverage for the child.
    (g) The commissioner of human services must publish a table with the premium schedule for
public coverage and update the chart for changes to the schedule by July 1 of each year.
    Subd. 5. Medical support costs; unreimbursed and uninsured medical expenses. (a)
Unless otherwise agreed to by the parties and approved by the court, the court must order that
the cost of health care coverage and all unreimbursed and uninsured medical expenses under the
health plan be divided between the obligor and obligee based on their proportionate share of
the parties' combined monthly PICS.
    (b) If a party owes a joint child support obligation for a child and is ordered to carry health
care coverage for the joint child, and the other party is ordered to contribute to the carrying party's
cost for coverage, the carrying party's child support payment must be reduced by the amount of
the contributing party's contribution.
    (c) If a party owes a joint child support obligation for a child and is ordered to contribute to
the other party's cost for carrying health care coverage for the joint child, the contributing party's
child support payment must be increased by the amount of the contribution.
    (d) If the party ordered to carry health care coverage for the joint child already carries
dependent health care coverage for other dependents and would incur no additional premium
costs to add the joint child to the existing coverage, the court must not order the other party to
contribute to the premium costs for coverage of the joint child.
    (e) If a party ordered to carry health care coverage for the joint child does not already carry
dependent health care coverage but has other dependents who may be added to the ordered
coverage, the full premium costs of the dependent health care coverage must be allocated between
the parties in proportion to the party's share of the parties' combined PICS, unless the parties
agree otherwise.
    (f) If a party ordered to carry health care coverage for the joint child is required to enroll in a
health plan so that the joint child can be enrolled in dependent health care coverage under the
plan, the court must allocate the costs of the dependent health care coverage between the parties.
The costs of the health care coverage for the party ordered to carry the coverage for the joint
child must not be allocated between the parties.
    Subd. 6. Notice or court order sent to party's employer, union, or health carrier. (a) The
public authority must forward a copy of the national medical support notice or court order for
health care coverage to the party's employer within two business days after the date the party is
entered into the work reporting system under section 256.998.
    (b) The public authority or a party seeking to enforce an order for health care coverage must
forward a copy of the national medical support notice or court order to the obligor's employer or
union, or to the health carrier under the following circumstances:
    (1) the party ordered to carry health care coverage for the joint child fails to provide written
proof to the other party or the public authority, within 30 days of the effective date of the court
order, that the party has applied for health care coverage for the joint child;
    (2) the party seeking to enforce the order or the public authority gives written notice to the
party ordered to carry health care coverage for the joint child of its intent to enforce medical
support. The party seeking to enforce the order or public authority must mail the written notice to
the last known address of the party ordered to carry health care coverage for the joint child; and
    (3) the party ordered to carry health care coverage for the joint child fails, within 15 days
after the date on which the written notice under clause (2) was mailed, to provide written proof
to the other party or the public authority that the party has applied for health care coverage for
the joint child.
    (c) The public authority is not required to forward a copy of the national medical support
notice or court order to the obligor's employer or union, or to the health carrier, if the court orders
health care coverage for the joint child that is not employer-based or union-based coverage.
    Subd. 7. Employer or union requirements. (a) An employer or union must forward the
national medical support notice or court order to its health plan within 20 business days after the
date on the national medical support notice or after receipt of the court order.
    (b) Upon determination by an employer's or union's health plan administrator that a joint
child is eligible to be covered under the health plan, the employer or union and health plan must
enroll the joint child as a beneficiary in the health plan, and the employer must withhold any
required premiums from the income or wages of the party ordered to carry health care coverage
for the joint child.
    (c) If enrollment of the party ordered to carry health care coverage for a joint child is
necessary to obtain dependent health care coverage under the plan, and the party is not enrolled in
the health plan, the employer or union must enroll the party in the plan.
    (d) Enrollment of dependents and, if necessary, the party ordered to carry health care
coverage for the joint child must be immediate and not dependent upon open enrollment periods.
Enrollment is not subject to the underwriting policies under section 62A.048.
    (e) Failure of the party ordered to carry health care coverage for the joint child to execute
any documents necessary to enroll the dependent in the health plan does not affect the obligation
of the employer or union and health plan to enroll the dependent in a plan. Information and
authorization provided by the public authority, or by a party or guardian, is valid for the purposes
of meeting enrollment requirements of the health plan.
    (f) An employer or union that is included under the federal Employee Retirement Income
Security Act of 1974 (ERISA), United States Code, title 29, section 1169(a), may not deny
enrollment to the joint child or to the parent if necessary to enroll the joint child based on
exclusionary clauses described in section 62A.048.
    (g) A new employer or union of a party who is ordered to provide health care coverage for a
joint child must enroll the joint child in the party's health plan as required by a national medical
support notice or court order.
    Subd. 8. Health plan requirements. (a) If a health plan administrator receives a completed
national medical support notice or court order, the plan administrator must notify the parties, and
the public authority if the public authority provides support enforcement services, within 40
business days after the date of the notice or after receipt of the court order, of the following:
    (1) whether coverage is available to the joint child under the terms of the health plan and, if
not, the reason why coverage is not available;
    (2) whether the joint child is covered under the health plan;
    (3) the effective date of the joint child's coverage under the health plan; and
    (4) what steps, if any, are required to effectuate the joint child's coverage under the health
plan.
    (b) If the employer or union offers more than one plan and the national medical support notice
or court order does not specify the plan to be carried, the plan administrator must notify the parents
and the public authority if the public authority provides support enforcement services. When there
is more than one option available under the plan, the public authority, in consultation with the
parent with whom the joint child resides, must promptly select from available plan options.
    (c) The plan administrator must provide the parents and public authority, if the public
authority provides support enforcement services, with a notice of the joint child's enrollment,
description of the coverage, and any documents necessary to effectuate coverage.
    (d) The health plan must send copies of all correspondence regarding the health care
coverage to the parents.
    (e) An insured joint child's parent's signature is a valid authorization to a health plan for
purposes of processing an insurance reimbursement payment to the medical services provider or
to the parent, if medical services have been prepaid by that parent.
    Subd. 9. Employer or union liability. (a) An employer or union that willfully fails to comply
with the order or notice is liable for any uninsured medical expenses incurred by the dependents
while the dependents were eligible to be enrolled in the health plan and for any other premium
costs incurred because the employer or union willfully failed to comply with the order or notice.
    (b) An employer or union that fails to comply with the order or notice is subject to a contempt
finding, a $250 civil penalty under section 518A.73, and is subject to a civil penalty of $500 to be
paid to the party entitled to reimbursement or the public authority. Penalties paid to the public
authority are designated for child support enforcement services.
    Subd. 10. Contesting enrollment. (a) A party may contest a joint child's enrollment in a
health plan on the limited grounds that the enrollment is improper due to mistake of fact or that
the enrollment meets the requirements of section 518.145.
    (b) If the party chooses to contest the enrollment, the party must do so no later than 15 days
after the employer notifies the party of the enrollment by doing the following:
    (1) filing a motion in district court or according to section 484.702 and the expedited child
support process rules if the public authority provides support enforcement services;
    (2) serving the motion on the other party and public authority if the public authority provides
support enforcement services; and
    (3) securing a date for the matter to be heard no later than 45 days after the notice of
enrollment.
    (c) The enrollment must remain in place while the party contests the enrollment.
    Subd. 11. Disenrollment; continuation of coverage; coverage options. (a) Unless a court
order provides otherwise, a child for whom a party is required to provide health care coverage
under this section must be covered as a dependent of the party until the child is emancipated, until
further order of the court, or as consistent with the terms of the coverage.
    (b) The health carrier, employer, or union may not disenroll or eliminate coverage for the
child unless:
    (1) the health carrier, employer, or union is provided satisfactory written evidence that the
court order is no longer in effect;
    (2) the joint child is or will be enrolled in comparable health care coverage through another
health plan that will take effect no later than the effective date of the disenrollment;
    (3) the employee is no longer eligible for dependent coverage; or
    (4) the required premium has not been paid by or on behalf of the joint child.
    (c) The health plan must provide 30 days' written notice to the joint child's parents, and the
public authority if the public authority provides support enforcement services, before the health
plan disenrolls or eliminates the joint child's coverage.
    (d) A joint child enrolled in health care coverage under a qualified medical child support
order, including a national medical support notice, under this section is a dependent and a
qualified beneficiary under the Consolidated Omnibus Budget and Reconciliation Act of 1985
(COBRA), Public Law 99-272. Upon expiration of the order, the joint child is entitled to the
opportunity to elect continued coverage that is available under the health plan. The employer or
union must provide notice to the parties and the public authority, if it provides support services,
within ten days of the termination date.
    (e) If the public authority provides support enforcement services and a plan administrator
reports to the public authority that there is more than one coverage option available under the
health plan, the public authority, in consultation with the parent with whom the joint child resides,
must promptly select coverage from the available options.
    Subd. 12. Spousal or former spousal coverage. The court must require the parent with
whom the joint child does not reside to provide dependent health care coverage for the benefit of
the parent with whom the joint child resides if the parent is ordered to provide dependent health
care coverage for the parties' joint child and adding the other parent to the coverage results in
no additional premium cost.
    Subd. 13. Disclosure of information. (a) If the public authority provides support
enforcement services, the parties must provide the public authority with the following information:
    (1) information relating to dependent health care coverage or public coverage available for
the benefit of the joint child for whom support is sought, including all information required to be
included in a medical support order under this section;
    (2) verification that application for court-ordered health care coverage was made within 30
days of the court's order; and
    (3) the reason that a joint child is not enrolled in court-ordered health care coverage, if a joint
child is not enrolled in coverage or subsequently loses coverage.
    (b) Upon request from the public authority under section 256.978, an employer, union, or
plan administrator, including an employer subject to the federal Employee Retirement Income
Security Act of 1974 (ERISA), United States Code, title 29, section 1169(a), must provide the
public authority the following information:
    (1) information relating to dependent health care coverage available to a party for the benefit
of the joint child for whom support is sought, including all information required to be included in
a medical support order under this section; and
    (2) information that will enable the public authority to determine whether a health plan
is appropriate for a joint child, including, but not limited to, all available plan options, any
geographic service restrictions, and the location of service providers.
    (c) The employer, union, or plan administrator must not release information regarding one
party to the other party. The employer, union, or plan administrator must provide both parties with
insurance identification cards and all necessary written information to enable the parties to utilize
the insurance benefits for the covered dependent.
    (d) The public authority is authorized to release to a party's employer, union, or health plan
information necessary to verify availability of dependent health care coverage, or to establish,
modify, or enforce medical support.
    (e) An employee must disclose to an employer if medical support is required to be withheld
under this section and the employer must begin withholding according to the terms of the order
and under section 518A.53. If an employee discloses an obligation to obtain health care coverage
and coverage is available through the employer, the employer must make all application processes
known to the individual and enroll the employee and dependent in the plan.
    Subd. 14. Child support enforcement services. The public authority must take necessary
steps to establish and enforce an order for medical support if the joint child receives public
assistance or a party completes an application for services from the public authority under section
518A.51.
    Subd. 15. Enforcement. (a) Remedies available for collecting and enforcing child support
apply to medical support.
    (b) For the purpose of enforcement, the following are additional support:
    (1) the costs of individual or group health or hospitalization coverage;
    (2) dental coverage;
    (3) medical costs ordered by the court to be paid by either party, including health and dental
insurance premiums paid by the obligee because of the obligor's failure to obtain coverage as
ordered; and
    (4) liabilities established under this subdivision.
    (c) A party who fails to carry court-ordered dependent health care coverage is liable for the
joint child's uninsured medical expenses unless a court order provides otherwise. A party's failure
to carry court-ordered coverage, or to provide other medical support as ordered, is a basis for
modification of a support order under section 518A.39, subdivision 2.
    (d) Payments by the health carrier or employer for services rendered to the dependents that
are directed to a party not owed reimbursement must be endorsed over to and forwarded to the
vendor or appropriate party or the public authority. A party retaining insurance reimbursement not
owed to the party is liable for the amount of the reimbursement.
    Subd. 16. Offset. (a) If a party is the parent with primary physical custody as defined in
section 518A.26, subdivision 17, and is an obligor ordered to contribute to the other party's cost
for carrying health care coverage for the joint child, the other party's child support obligation is
subject to an offset under subdivision 5.
(b) The public authority, if the public authority provides services, may remove the offset to a
party's child support obligation when:
(1) the party's court-ordered health care coverage for the joint child terminates;
(2) the party does not enroll the joint child in other health care coverage; and
(3) a modification motion is not pending.
The public authority must provide notice to the parties of the action.
    (c) A party may contest the public authority's action to remove the offset to the child support
obligation if the party makes a written request for a hearing within 30 days after receiving written
notice. If a party makes a timely request for a hearing, the public authority must schedule a
hearing and send written notice of the hearing to the parties by mail to the parties' last known
addresses at least 14 days before the hearing. The hearing must be conducted in district court
or in the expedited child support process if section 484.702 applies. The district court or child
support magistrate must determine whether removing the offset is appropriate and, if appropriate,
the effective date for the removal.
    (d) If the party does not request a hearing, the public authority will remove the offset
effective the first day of the month following termination of the joint child's health care coverage.
    Subd. 17. Collecting unreimbursed or uninsured medical expenses. (a) This subdivision
and subdivision 18 apply when a court order has determined and ordered the parties' proportionate
share and responsibility to contribute to unreimbursed or uninsured medical expenses.
(b) A party requesting reimbursement of unreimbursed or uninsured medical expenses must
initiate a request to the other party within two years of the date that the requesting party incurred
the unreimbursed or uninsured medical expenses. If a court order has been signed ordering the
contribution towards unreimbursed or uninsured expenses, a two-year limitations provision
must be applied to any requests made on or after January 1, 2007. The provisions of this section
apply retroactively to court orders signed before January 1, 2007. Requests for unreimbursed or
uninsured expenses made on or after January 1, 2007, may include expenses incurred before
January 1, 2007, and on or after January 1, 2005.
    (c) A requesting party must mail a written notice of intent to collect the unreimbursed or
uninsured medical expenses and a copy of an affidavit of health care expenses to the other party at
the other party's last known address.
    (d) The written notice must include a statement that the other party has 30 days from the
date the notice was mailed to (1) pay in full; (2) agree to a payment schedule; or (3) file a motion
requesting a hearing to contest the amount due or to set a court-ordered monthly payment amount.
If the public authority provides services, the written notice also must include a statement that, if
the other party does not respond within the 30 days, the requesting party may submit the amount
due to the public authority for collection.
    (e) The affidavit of health care expenses must itemize and document the joint child's
unreimbursed or uninsured medical expenses and include copies of all bills, receipts, and
insurance company explanations of benefits.
(f) If the other party does not respond to the request for reimbursement within 30 days, the
requesting party may commence enforcement against the other party under subdivision 18; file a
motion for a court-ordered monthly payment amount under paragraph (i); or notify the public
authority, if the public authority provides services, that the other party has not responded.
    (g) The notice to the public authority must include: a copy of the written notice, a copy of
the affidavit of health care expenses, and copies of all bills, receipts, and insurance company
explanations of benefits.
    (h) If noticed under paragraph (f), the public authority must serve the other party with a
notice of intent to enforce unreimbursed and uninsured medical expenses and file an affidavit of
service by mail with the district court administrator. The notice must state that the other party has
14 days to (1) pay in full; or (2) file a motion to contest the amount due or to set a court-ordered
monthly payment amount. The notice must also state that if there is no response within 14 days,
the public authority will commence enforcement of the expenses as arrears under subdivision 18.
    (i) To contest the amount due or set a court-ordered monthly payment amount, a party
must file a timely motion and schedule a hearing in district court or in the expedited child
support process if section 484.702 applies. The moving party must provide the other party and
the public authority, if the public authority provides services, with written notice at least 14 days
before the hearing by mailing notice of the hearing to the public authority and to the requesting
party at the requesting party's last known address. The moving party must file the affidavit of
health care expenses with the court at least five days before the hearing. The district court or
child support magistrate must determine liability for the expenses and order that the liable party
is subject to enforcement of the expenses as arrears under subdivision 18 or set a court-ordered
monthly payment amount.
    Subd. 18. Enforcing unreimbursed or uninsured medical expenses as arrears. (a)
Unreimbursed or uninsured medical expenses enforced under this subdivision are collected
as arrears.
(b) If the liable party is the parent with primary physical custody as defined in section
518A.26, subdivision 17, the unreimbursed or uninsured medical expenses must be deducted from
any arrears the requesting party owes the liable party. If unreimbursed or uninsured expenses
remain after the deduction, the expenses must be collected as follows:
(1) If the requesting party owes a current child support obligation to the liable party, 20
percent of each payment received from the requesting party must be returned to the requesting
party. The total amount returned to the requesting party each month must not exceed 20 percent of
the current monthly support obligation.
(2) If the requesting party does not owe current child support or arrears, a payment
agreement under section 518A.69 is required. If the liable party fails to enter into or comply
with a payment agreement, the requesting party or the public authority, if the public authority
provides services, may schedule a hearing to set a court-ordered payment. The requesting party
or the public authority must provide the liable party with written notice of the hearing at least
14 days before the hearing.
(c) If the liable party is not the parent with primary physical custody as defined in section
518A.26, subdivision 17, the unreimbursed or uninsured medical expenses must be deducted from
any arrears the requesting party owes the liable party. If unreimbursed or uninsured expenses
remain after the deduction, the expenses must be added and collected as arrears owed by the
liable party.
History: 2005 c 164 s 22,29; 1Sp2005 c 7 s 26,28; 2006 c 280 s 32-37