Maximum Health Insurance Cost for Child Support

Health insurance for children is an integral component of child support orders in Texas. Under Section 154.181 of the Texas Family Code, courts are required to address health care coverage for the child in every child support order. If reasonable-cost health insurance is available to either parent through employment or otherwise, the court will order that parent to provide coverage for the child.

The Texas Family Code defines "reasonable cost" as a cost that does not exceed 9 percent of the obligor's annual gross income. This threshold is important because it limits the financial burden that can be imposed on the paying parent for health insurance premiums alone. If the cost of adding the child to the obligor's employer-provided plan exceeds this percentage, the court may look to the other parent's available coverage or explore alternative arrangements.

When health insurance is ordered, the cost of the child's portion of the premium is typically factored into the overall child support calculation. Specifically, the obligor's share of the health insurance premium for the child is deducted from gross income before calculating net resources, which means it reduces the base from which the support percentage is applied. This prevents the obligor from being effectively double-charged for insurance costs.

In addition to basic health insurance, courts may order parents to share uninsured medical expenses — including deductibles, co-pays, and costs for services not covered by insurance — in proportion to their incomes or on some other equitable basis. Dental and vision coverage may also be addressed in the order. Parents should pay close attention to the specific terms of their order regarding medical expense sharing, as these provisions are enforceable just like the base child support amount.

If neither parent has access to reasonable-cost health insurance, the court may order cash medical support instead. Cash medical support is a fixed monthly amount that the obligor pays to help cover the child's health care costs. Texas law caps cash medical support, in combination with the child support obligation, at a percentage of the obligor's net resources to prevent an excessive overall financial burden.