Health Insurance

What is my responsibility as an employer with regard to health insurance?

The Application & Order for Health Insurance ("HICA"), becomes effective within 20 days, and must be given to your employee within 10 days after it was served on you, per FC 3764.

You must begin to maintain health insurance coverage of the employee’s dependents named on the order, if health insurance coverage is available, within 30 days unless you receive notice of a motion to quash the HICA, per FC 3766. The cost of health insurance shall be in addition to the child support amount ordered, per FC 3753.

The total amount that may be withheld from earnings for all obligations, including health insurance assignments, is limited by the 50% rule, per FC 3671(c).

What are my employee’s options to stop the HICA? What if the cost is too high?

Your employee may go to court to quash a HICA on certain grounds, one of which is that the amount to be withheld for premiums is unreasonable, per FC 3765. The court might find that the HICA would cause extraordinary hardship to the employee, per FC 3762. Your employee can be referred to the Shasta Family Law Facilitator, (530) 245-6900, for no cost help in filing the necessary paperwork to go to court.

What if we don’t have health insurance coverage available to our employees?

If health insurance is not available to the employee, complete and sign the Declaration of No Health Insurance Coverage on the reverse of the HICA and mail the form within 20 days to DCSS, per FC 3766(c). If you have information that your employee has a health plan through a Union, please let us know so that DCSS can forward the HICA to the appropriate Union.

If the children are not covered, what plan, and/or physician should I choose?

Health insurance coverage under a HICA includes vision care and dental care coverage whether the vision care or dental care coverage is part of existing health insurance coverage or is issued as a separate policy or plan, per FC 3750.

You may enroll the children under the same health benefit plan in which your employee is enrolled. If the employee is offered more than one health plan, the plan chosen by the employee must provide coverage for dependents.

If your plan calls for a parent to select a primary care physician, try to work with the custodial party. If you do not have a response from parent(s), then you may choose the primary care physician (most likely you will choose a pediatrician). The parent(s) may then change the physician later if they choose to do so.

There is an additional cost to our employee for dental coverage. Are we required to provide dental coverage as part of the insurance requirement?

Many plans require everybody in the family to have the same coverage. You should call your carrier and ask if you can put the child on all available coverage’s. In general, keep coverage’s consistent and accommodate the plan requirements.

What if our employee has voluntarily elected not to maintain any insurance?

If your employee is not enrolled in a plan and there is a choice of several plans, you may enroll the children in any plan that will reasonably provide benefits or coverage where they live, unless the court has ordered coverage by a specific plan, per FC 3766(c).

If coverage is available, but the insurance company will not provide coverage for the child, should I call DCSS?

If the insurance company will not cover the child alone, please contact DCSS and, if possible, give us the cost of the insurance.

Can I wait for open enrollment to commence coverage?

No. You must commence coverage at the earliest possible time and, if applicable, consistent with the group plan enrollment rules, per FC 3766(a). Do not delay enrollment until the plan’s open enrollment period if it would violate time requirements, per FC 3751.5(b)1.

Must I wait for our new employee to become eligible for health insurance before I can enroll the child?

If you receive a HICA and your employee is not yet eligible for insurance, you may enroll the child if your organization and your health insurance company allow it. Note that, if your organization offers insurance ONLY to employees, not their spouses or families, then you would not be obligated to enroll the child.

What if our employee already has existing health insurance for the children?

The existing health coverage shall be replaced only if the children are not provided reasonable benefits under the existing coverage where they reside, per FC 3766(b).

What should I do if there is a lapse in coverage?

In the event that there is any lapse in coverage (as with some seasonal employment), it is your responsibility to contact DCSS when the coverage stops and then to contact DCSS when coverage resumes, per FC 3771(e). You may photocopy the "lapse of coverage" letter and send it to DCSS each time.

I received a Medical Insurance Form with the HICA. Am I required to complete it?

Yes. If you cover the children with health insurance you should complete the Medical Insurance Form and mail it to the address at the top of the form, per FC 3767.

Do I pay the premiums directly to the insurance provider?

Yes. Not to DCSS.

What are my duties to the non-employee parent? Where do I send the medical cards for the dependents?

You must provide evidence of coverage and any information necessary for the child to obtain benefits through the coverage to both parents and the person having custody of the child and to DCSS when requested. Upon request by the parents or person having custody of the child, provide all forms and other documentation necessary for the purpose of submitting claims to the insurance carrier, per FC 3767.

The letters you receive from DCSS will provide you with the address of the custodial party. If you do not find an address on the letters, you should send them to the DCSS and we will make sure they are forwarded. Do not release the custodial party’s address or phone number to the noncustodial parent or to anyone except the insurance provider.

What if the payment of the health insurance premium combined with the amount of current child support causes the employee’s net disposable earnings to be less than 50%?

In computing 50% of the disposable earnings, the first priority is the current support, then the cost of providing health insurance for the child, then the support arrears.

Examples for computing health insurance costs and applying the 50% rule

  • Example 1: 50% of your employee’s net disposable income equals $800. There is an order for current child support of $500. There is an order for a child support arrears payment of $200. The health insurance premium monthly equals $200. You would reduce the payment on arrears to $100 to keep the total deduction within the 50% maximum.
  • Example 2: 50% of your employee’s net disposable income equals $800. Child support is $600 each month. The health insurance premium equals $300. In this case, you would contact DCSS and we will contact the other parent if he/she is not aided. DCSS would then advise you whether the other parent has decided to opt for health insurance coverage in lieu of the full amount of child support. In most cases, you will be requested to complete the Declaration of No Health insurance Coverage and return it to DCSS. Keep in mind that if the cost of providing health insurance changes, you will still need to begin the enrollment process.
  • Example 3: Your employee’s net income fluctuates from month to month. Some months child support plus health insurance exceed 50% of the disposable earnings. In this case, contact DCSS for a decision and we will advise you whether to pay it part of the time or complete the Declaration of No Health Insurance Coverage and return it to DCSS.