Calculating Health Ins Premiums

[mad_as_hell]

The agreement signed between T and his ex says that they are to pay the health ins. premium "equally". C is on her step father's med ins. Also on this med. ins. are step-father, J (the ex), and their three children. A total of 6 people. To calculate C's portion of the premium, J claims that in "speaking with other mothers", because it is a family plan it does not matter that there are 6 people on the plan. Therefore it is only "fair" to divide the premium per pay period by only 4 people. But, we are of the opinion that each person iis still being covered under that plan and each person in the household then still accounts for a portion of that premium per pay period. Therefore, shouldn't we be dividing the premium by 6 to get C's portion? That seems fair to me because C is T's only child. Isn't this just a way for her to get him to pay for some of her other children's expenses?! What do you think?

[socrateaser]

> What do you think?

I think that you should ask the other parent to provide you with a breakdown from the insurance provider of the amount that it costs in order to insure the primary insured party (i.e., the step-parent/employee) by himself, and the cost of insuring the step-parent plus one child. Subtract one amount from the other and you have the cost of insuring one child.

That is the amount that you should be obligated to pay.

[socrateaser]

1. One could just as easily argue that you should only have to pay the "actual" cost of insuring the child. That is, after insuring all of the other persons, what is the additional cost required to insure one remaining child?

2. Or, one could argue that the cost should be the average cost of insuring all the children, after insuring the primary insured (step-parent).

My thought in the previous post is probably the most costly to you. while my argument in #1, above is probably the least costly.

I'd pick the cheapest and let the other side try to argue their point, and hopefully meet in the center, without going to court.

[DecentDad]

Hi,

Being an employee of a mega-bureaucratic entity, I'm pretty familiar with how such plans work, whereas independent or small-office professionals may have a different perspective.

My options for my health plan are:

I pay a certain monthly contribution to insure myself.

I can also (and separate from my child) pay an additional monthly contribution for my wife.

I can also (and separate from my wife) pay an additional monthly contribution for my child OR children.

Instead of all of the above options, I can pay a monthly contribution to insure my "family", which is less than the sum of the above, and includes all eligible children regardless of quantity.

-------------

So, the "add on" cost of this poster's child is probably zero, provided the stepdad is insuring his own kids (perhaps through his own custody orders?).

I think it'd be reasonable to argue that if the add-on cost for this child is zero, the mother has no actual burden.

But at the time that said policy becomes unavailable or the mother puts child on a different policy that has a measurable cost for this child, then it goes back to splitting it.

A word of caution for the poster, however.  When examining whether my wife's employer or mine offered a better plan for our needs, we discovered that her company would not cover an unnatural stepchild unless the child has been adopted by the stepparent (i.e., regardless of a married household).  That ruled out her plan for family coverage.

It may be worth your while, for the best interest of your child and your pocketbook in the event of major health needs, to look up eligibility restrictions of the plan on which your child is placed.  It's possible that an unadopted stepchild isn't eligible.  Of course, this would require mother to find other insurance for the child, making you pay half.  That's better than to face $100k in medical bills and suddenly be told by the insurer that the child was never eligible to be on the plan.

DD

[mad_as_hell]

Thanks for all your replies.

The agreement says that CP and NCP pay "equally" or 50/50 no matter what, so we have to pay for 50% of child's portion of the plan.  So are you saying that if it's a family plan that there is really no cost to her and we shouldn't even be paying anything?  And two days ago we received the breakdown of what is coming out of her husband's paycheck but this time she finally gave us proof via a copy of the official paperwork from her husband's human  resources when he had to sign up.  The total premium per pay period (off the top of my head) is something like $122 bi-weekly.  So we figured that it's about $61 per week divided by 6 people on the plan = about $10.17 for C's portion and split between ex and T should be about $5.08 per week per parent.  J says we should only divide by 4 to "fair" to all involved.  For pete's sake, the woman doens't work and her husband works at Home depot in PA.  How much money could he be making?!  (Sarcastic rhetorical question)  I am going to print out your remark and ask the lawyer to question it.  And actually, paying for C to be on a seperate policy all her own is not that expensive in PA.  We checked it.   But we didn't know about the possibility of her not being covered - J doesn't let us see anything she doesn't want us to see.

[socrateaser]

1. Your logic will cause you to pay for more than you would ordinarily owe. The question is what is the actual cost of insuring one child? That is a number that the healthcare provider can absolutely produce, because, regardless of how the stepfather is being billed, the insurer KNOWS what it costs to insure one child.

2. Please post the EXACT terms of your court order, re insurance. You keep referring to an agreement. Is the agreement court ordered, or is this a contract between yourself and the other parent?

Parents cannot bargain away a child's right to support/healthcare insurance, so unless this "agreement" is signed by a judge, it is probably invalid and unenforceable. But, depending on the exact wording, it may be enforceable, so please post the text so we can eliminate all ambiguities.

[mad_as_hell]

The agreement IS signed by a judge in the state of New Jersey.  It IS court ordered which is why I said we have to pay 50% of C's health ins. premium.  The order states exactly this,

"Either parent may provide health insurance for the child so long as it is provided through his or her employer.  Each parent will be equally responsible for the health insurance premium attributable to the minor child."

This agreement was signed in NJ back in 1999 and is filed with the NJ courts.

[socrateaser]

>The agreement IS signed by a judge in the state of New
>Jersey.  It IS court ordered which is why I said we have to
>pay 50% of C's health ins. premium.  The order states exactly
>this,
>
>"Either parent may provide health insurance for the child so
>long as it is provided through his or her employer.  Each
>parent will be equally responsible for the health insurance
>premium attributable to the minor child."
>
>This agreement was signed in NJ back in 1999 and is filed with
>the NJ courts.

Well, see, now, you actually have another means of getting some leverage. You could find the most expensive plan available from your employer and then tell your ex that if you cannot come to some reasonable negotiated settlement in the near future, that you will accept the plan and send her a bill for one half of the premium.

Anyway, thanks for posting the text of your order -- it clears up the ambiguity. My previous advice remains unchanged.

[MixedBag]

Asked EX how many were insured (he said 4).  Then took his total cost and divided it by 4.

Didn't matter that our son was added last and that there was no increase as a result.

Asked me how many were insured (I said 7).  Then took that total and divided it out by 7.

Didn't matter that we took on the coverage as a result of my military retirement to get back to the level of coverage we had while I was on active duty and that I'm court ordered to provide insurance (EX is not ordered to provide anything).

That's just what he did.

DH's Judge didn't take medical into consideration at all, period, on either side.

[Troubledmom]

And what ours did was subtract the amount for the policy holder then divided the balance by the number of persons covered.

In our case monthly premium was $360. For the policy holder alone the premium was $200. There were 5 additional persons covered after the policy holder. They divided $160 by 5 coming to the sum of $32 per person for coverage costs per person.

TM