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Who Provides Health Insurance for the Children After a Divorce?

Who Provides Health Insurance for the Children After a Divorce?
Axelrod & Associates, P.A.

Parents must provide medical support for their children, and, in most cases, the family court will order one or both parents to maintain health insurance for the children after a divorce.

But who pays?

Below, we will discuss how the court determines who pays for the children’s medical insurance after a divorce, including:

  • Who is required to pay for health insurance for the children,
  • Who is required to pay for uninsured medical expenses for a child, and
  • What the SC Child Support Guidelines say about health insurance coverage and uninsured medical expenses.


Ideally, the parents will reach an agreement as to who provides health insurance for their children based on the unique circumstances of each case. If the parents do not reach an agreement through negotiations or mediation, the family court will decide who is responsible for insurance and include it in the final divorce and custody order.

If one of the parents has health insurance through their employment, the court may order that parent to continue providing medical coverage and their child support obligation may be reduced (or increased) accordingly.

If both parents have medical insurance that covers the child, the court may order the parent with the better insurance plan to continue providing coverage, or the children may continue to be covered under both plans, with a “primary” and a “secondary” insurance policy.

The parents (or the court) should consider the costs of insurance premiums, deductibles, co-pays, and uninsured medical expenses when determining which parent will be responsible for providing insurance coverage for the children.

SC Child Support Guidelines

The SC Child Support Guidelines direct the court to consider the health care needs of the children when calculating child support, including the costs of health insurance and uninsured medical expenses.

“Health insurance costs” is one of the factors that the court must consider when calculating child support, and is one of the fields you must fill in when you use DSS’s online child support calculator.

The guidelines direct the court to “require coverage by one or both parents who can obtain the most comprehensive coverage through an employer or otherwise, at the most reasonable cost.”

What about when an employer pays a portion of the insurance costs?

When the employer pays part of the insurance premiums, only the amount that is actually paid by the employee should be considered in the child support determination. Also, only the amount that is paid on behalf of the child should be considered, which could be:

  • The difference in cost between self-only coverage and family coverage,
  • The cost of private medical insurance specific to the child, or
  • The total cost of the insurance premium, divided by the total number of children covered by the policy, then multiplied by the number of children covered by the child support order.

The parent who is responsible for paying the child’s health insurance premiums then receives a “credit” that reduces the amount of child support they are responsible for paying (or increases the amount of child support they will receive).


What about uninsured medical expenses?

These expenses must also be accounted for and include:

  • Co-pays for doctor appointments,
  • Over-the-counter medications,
  • Insurance deductibles,
  • Uninsured dental or vision expenses,
  • Out-of-network costs,
  • Costs of medical equipment,
  • Mental health therapy or counseling, or
  • Other medically necessary expenses that are not covered by insurance.

What do the Guidelines Say About Uninsured Medical Expenses?

The Child Support Guidelines assume that the custodial parent will be responsible for up to $250/ year in uninsured medical expenses, and this is included in the initial child support calculations.

Reasonable and necessary medical expenses above $250/ year must also be accounted for, however. All unreimbursed uninsured medical costs should be 1) calculated and 2) divided between the parents “in pro rata percentages based on the proportional share of combined monthly adjusted gross income.”

Whether a medical expense is “reasonable and necessary” is in the court’s discretion, but costs like insurance deductibles, professional counseling, dentists, and eye care will usually be included.

Note also that SC Code § 63-17-470 lists factors that the court can consider to 1) deviate from the child support guidelines or 2) modify an existing child support order based on a change in circumstances, and these factors include “unreimbursed extraordinary medical or dental expenses for the noncustodial or custodial parent.”

Separation Agreements and Settlement Agreements

Your settlement agreement with your former spouse should contain a provision that specifies 1) who pays for insurance premiums for the child and 2) what percentage each parent pays for uninsured medical expenses and how the costs will be reimbursed.

In cases where there is no provision for uninsured medical costs or the other parent refuses to reimburse uninsured medical expenses, your child support attorney may be able to either 1) get a modification of your child support order to include the extraordinary medical costs or 2) take your former spouse to court to force them to pay their share of your child’s medical costs.


Depending on your circumstances, your SC child support attorney on the Axelrod team will help you to:

Call your SC child support attorney at Axelrod and Associates now at 843-353-3449 or send us a message through our website to find out how we can help.

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