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Medical reimbursement

Information on medical reimbursement

Health Care Expenses


The Michigan Child Support Formula requires each party to pay a percentage of the minor children’s uninsured health care expenses. The Uniform Child Support Order (UCSO) will state the court ordered percentages. In addition, the UCSO may include an Annual Ordinary Medical (AOM) amount. If this provision is stated in the UCSO, the custodial party may not seek reimbursement from the non-custodial party until the expenses for the minor child/ren exceed the entire AOM amount. The non-custodial party is not required to meet the AOM amount, as their share of the minor child/ren’s “ordinary” health care expenses is included in the monthly support obligation. Therefore, the non-custodial party may seek reimbursement from the custodial party at any time for expenses incurred by the minor child/ren. If either party fails to pay their percentage of the health care expenses, Friend of the Court (FOC) will assist in reimbursement.  


Reimbursement forms (FOC 13 & FOC 13a) are available online or at the FOC office. You must complete the Request for Health Care Expense Payment form (FOC 13) listing each expense separately and submit to the other party with supporting documentation (e.g. bills, receipts, Explanation of Benefits). The documentation must state provider name, patient name, date of service, type of service, insurance payments/adjustments (if applicable), amount charged and/or paid. If direct payment is not received from the other party within 28 days, the expenses can be submitted to FOC. 


You must complete the Complaint and Notice for Health Care Expense Payment form (FOC 13a) and submit to FOC with a copy of the expense ledger and supporting documentation. Be advised that cash/credit card receipts are not acceptable, unless submitted with the bill as proof of payment. Only post judgment expenses submitted within 1 year of date of service, within 6 months of an insurer’s final payment/denial of claim, or within 6 months of default of an agreement qualify for assessment.

 
If the expense is orthodontics, the initial down payment must be submitted to FOC within 1 year of the date of contract. You must provide a copy of the signed contract/financial agreement and proof of payment(s). If you anticipate objections from the other party, it is recommended that you include a letter from the orthodontist explaining the necessity of treatment. Be advised that due to the cost and length of treatment, only monthly payments are eligible for submission.


Complaints received by FOC are typically processed within 4 weeks. Only expenses that qualify for assessment will be processed. Qualifying expenses include insurance co-payments, deductibles, and other uninsured health care costs. Remedial care items such as first aid supplies and over the counter medications/vitamins are included in the base support so those expenses do not qualify for assessment. 


Complaints submitted by the custodial party will be processed and the support account assessed for the non-custodial party’s court ordered percentage. Complaints submitted by the non-custodial party will be processed and the support account credited for the custodial party’s court ordered percentage. However, either party has the option to object to the assessment/credit. Written objections must be submitted to FOC within 21 days of the date the complaint was signed by the FOC Representative. 
 

Reimbursement forms

Health care insurance

The Michigan Child Support Formula requires one or both parties to maintain insurance for the minor child/ren. In addition, parties are required to keep Friend of the Court (FOC) informed of any insurance maintained for the minor child/ren:  name of insurer, address, phone number, effective date, policy number, and group number. It is preferred that you submit a copy of the insurance card(s), front and back. It is also recommended that you provide the other party with an insurance card(s) that can be utilized when taking the minor child/ren for health care treatment.


If a party is ordered to maintain insurance, a National Medical Support Notice (NMSN) will issue to the current and subsequent employers. The NMSN requires the employer to enroll the minor child/ren on the health care insurance, if available at a reasonable cost. The Uniform Child Support Order will state the reasonable cost percentage. If the cost (e.g. difference between self only & child/ren or family coverage) is less than the reasonable cost percentage, the employer is required to enroll the employee (if not currently enrolled) and the minor child/ren.


A Parent Health Care Coverage (PHCC) explanation sheet will be sent to both parties to inform them that a NMSN issued to the employer. If the employee has an objection to the enrollment, he/she should complete the objection form included with the PHCC explanation sheet and submit to FOC with any documentation that supports the objection. The objection will be reviewed by the Medical Specialist. If necessary, a letter will be sent to the employer to rescind  (revoke/cancel) the NMSN.


If either party fails to maintain insurance or provide insurance information, you may contact Medical Department for enforcement/assistance. If insurance is not available through employment, you may apply for insurance/Medicaid for the minor child/ren at www.healthcare.gov.

Any questions related to health care expenses or insurance, please contact the Medical Department at (586) 469-5160, or by email at friendofthecourt@macombgov.org.