N.Y. Family Court Act § 416: Elements of support; provisions for accident, life and health insurance benefits

§ 416. Elements of support; provisions for accident, life and health

insurance benefits. (a) The court may include in the requirements for an

order for support the providing of necessary shelter, food, clothing,

care, medical attention, expenses of confinement, the expense of

education, payment of funeral expenses, and other proper and reasonable

expenses.

(b) The court may also order a party to purchase, maintain, or assign

a policy of accident insurance or insurance on the life of either party

and designate in the case of life insurance, the person or persons on

whose behalf the petition is brought or in the case of accident

insurance, the insured party as irrevocable beneficiaries during a

period of time fixed by the court. The obligation to provide such

insurance shall cease upon the termination of such party's duty to

provide support.

(c) Every support order shall provide that if any legally responsible

relative currently, or at any time in the future, has health insurance

benefits available that may be extended or obtained to cover any person

on whose behalf the petition is brought, such responsible relative is

required to exercise the option of additional coverage in favor of such

person whom he or she is legally responsible to support and to execute

and deliver to such person any forms, notices, documents, or instruments

to assure timely payment of any health insurance claims for such person.

(d) As used in this section, the following terms shall have the

following meanings: (1) "Health insurance benefits" means any medical,

dental, optical and prescription drugs and health care services or other

health care benefits that may be provided for a dependent through an

employer or organization, including such employers or organizations

which are self insured, or through other available health insurance or

health care coverage plans.

(2) "Available health insurance benefits" means any health insurance

benefits that are reasonable in cost and that are reasonably accessible

to the person on whose behalf the petition is brought. Health insurance

benefits that are not reasonable in cost or whose services are not

reasonably accessible to such person shall be considered unavailable.

(3) When the person on whose behalf the petition is brought is a child

in accordance with subdivision (e) of this section, health insurance

benefits shall be considered "reasonable in cost" if the cost of health

insurance benefits does not exceed five percent of the combined parental

gross income. The cost of health insurance benefits shall refer to the

cost of the premium and deductible attributable to adding the child or

children to existing coverage or the difference between such costs for

self-only and family coverage. Provided, however, the presumption that

the health insurance benefits are reasonable in cost may be rebutted

upon a finding that the cost is unjust or inappropriate which finding

shall be based on the circumstances of the case, the cost and

comprehensiveness of the health insurance benefits for which the child

or children may otherwise be eligible, and the best interests of the

child or children. In no instance shall health insurance benefits be

considered "reasonable in cost" if a parent's share of the cost of

extending such coverage would reduce the income of that parent below the

self-support reserve. Health insurance benefits are "reasonably

accessible" if the child lives within the geographic area covered by the

plan or lives within thirty minutes or thirty miles of travel time from

the child's residence to the services covered by the health insurance

benefits or through benefits provided under a reciprocal agreement;

provided, however, this presumption may be rebutted for good cause shown

including, but not limited to, the special health needs of the child.

The court shall set forth such finding and the reasons therefor in the

order of support.

(e) When the person on whose behalf the petition is brought is a

child, the court shall consider the availability of health insurance

benefits to all parties and shall take the following action to insure

that health insurance benefits are provided for the benefit of the

child:

(1) Where the child is presently covered by health insurance benefits,

the court shall direct in the order of support that such coverage be

maintained, unless either parent requests the court to make a direction

for health insurance benefits coverage pursuant to paragraph two of this

subdivision.

(2) Where the child is not presently covered by health insurance

benefits, the court shall make its determination as follows:

(i) If only one parent has available health insurance benefits, the

court shall direct in the order of support that such parent provide

health insurance benefits.

(ii) If both parents have available health insurance benefits the

court shall direct in the order of support that either parent or both

parents provide such health insurance. The court shall make such

determination based on the circumstances of the case, including, but not

limited to, the cost and comprehensiveness of the respective health

insurance benefits and the best interests of the child.

(iii) If neither parent has available health insurance benefits, the

court shall direct in the order of support that the custodial parent

apply for the state's child health insurance plan pursuant to title

one-A of article twenty-five of the public health law and the medical

assistance program established pursuant to title eleven of article five

of the social services law. A direction issued under this subdivision

shall not limit or alter either parent's obligation to obtain health

insurance benefits at such time as they become available as required

pursuant to subdivision (c) of this section. Nothing in this subdivision

shall alter or limit the authority of the medical assistance program to

determine when it is considered cost effective to require a custodial

parent to enroll a child in an available group health insurance plan

pursuant to paragraphs (b) and (c) of subdivision one of section three

hundred sixty-seven-a of the social services law.

(f) The cost of providing health insurance benefits or benefits under

the state's child health insurance plan or the medical assistance

program, pursuant to subdivision (e) of this section, shall be deemed

cash medical support, and the court shall determine the obligation of

either or both parents to contribute to the cost thereof pursuant to

subparagraph five of paragraph (c) of subdivision one of section four

hundred thirteen of this part.

(g) The court shall provide in the order of support that the legally

responsible relative immediately notify the other party, or the other

party and the support collection unit when the order is issued on behalf

of a child in receipt of public assistance and care or in receipt of

services pursuant to section one hundred eleven-g of the social services

law, of any change in health insurance benefits, including any

termination of benefits, change in the health insurance benefit carrier,

premium, or extent and availability of existing or new benefits.

(h) Where the court determines that health insurance benefits are

available, the court shall provide in the order of support that the

legally responsible relative immediately enroll the eligible dependents

named in the order who are otherwise eligible for such benefits without

regard to any seasonal enrollment restrictions. The support order shall

further direct the legally responsible relative to maintain such

benefits as long as they remain available to such relative. Such order

shall further direct the legally responsible relative to assign all

insurance reimbursement payments for health care expenses incurred for

his or her eligible dependents to the provider of such services or the

party actually having incurred and satisfied such expenses, as

appropriate.

(i) When the court issues an order of child support or combined child

and spousal support on behalf of persons in receipt of public assistance

and care or in receipt of services pursuant to section one hundred

eleven-g of the social services law, such order shall further direct

that the provision of health care benefits shall be immediately enforced

pursuant to section fifty-two hundred forty-one of the civil practice

law and rules.

(j) When the court issues an order of child support or combined child

and spousal support on behalf of persons other than those in receipt of

public assistance and care or in receipt of services pursuant to section

one hundred eleven-g of the social services law, the court shall also

issue a separate order which shall include the necessary direction to

ensure the order's characterization as a qualified medical child support

order as defined by section six hundred nine of the employee retirement

income security act of 1974 (29 USC 1169). Such order shall: (i) clearly

state that it creates or recognizes the existence of the right of the

named dependent to be enrolled and to receive benefits for which the

legally responsible relative is eligible under the available group

health plans, and shall clearly specify the name, social security number

and mailing address of the legally responsible relative, and of each

dependent to be covered by the order; (ii) provide a clear description

of the type of coverage to be provided by the group health plan to each

such dependent or the manner in which the type of coverage is to be

determined; and (iii) specify the period of time to which the order

applies. The court shall not require the group health plan to provide

any type or form of benefit or option not otherwise provided under the

group health plan except to the extent necessary to meet the

requirements of a law relating to medical child support described in

section one thousand three hundred and ninety-six g-1 of title forty-two

of the United States code.

(k) Upon a finding that a legally responsible relative wilfully failed

to obtain health insurance benefits in violation of a court order, such

relative will be presumptively liable for all health care expenses

incurred on behalf of such dependents from the first date such

dependents were eligible to be enrolled to receive health insurance

benefits after the issuance of the order of support directing the

acquisition of such coverage.