Tex. Fam. Code § 154.181, § 154.1815, § 154.182

TEXAS FAMILY CODE Chapter 154, Subchapter D — MEDICAL SUPPORT AND DENTAL SUPPORT FOR CHILD CHAPTER 154 • CHILD SUPPORT Subchapter D: MEDICAL SUPPORT AND DENTAL SUPPORT FOR CHILD Sec. 154.181. MEDICAL SUPPORT ORDER. (a) The court shall render an order for the medical support of the child as provided by this section and Section 154.182 in: (1) a proceeding in which periodic payments of child support are ordered under this chapter or modified under Chapter 156; (2) any other suit affecting the parent-child relationship in which the court determines that medical support of the child must be established, modified, or clarified; or (3) a proceeding under Chapter 159. (b) Before a hearing on temporary orders or a final order, if no hearing on temporary orders is held, the court shall require the parties to the proceedings to disclose in a pleading or other statement: (1) if private health insurance is in effect for the child, the identity of the insurance company providing the coverage, the policy number, which parent is responsible for payment of any insurance premium for the coverage, whether the coverage is provided through a parent's employment, and the cost of the premium; or (2) if private health insurance is not in effect for the child, whether: (A) the child is receiving medical assistance under Chapter 32, Human Resources Code; (B) the child is receiving health benefits coverage under the state child health plan under Chapter 62, Health and Safety Code, and the cost of any premium; and (C) either parent has access to private health insurance at reasonable cost to the obligor. (c) In rendering temporary orders, the court shall, except for good cause shown, order that any health insurance coverage in effect for the child continue in effect pending the rendition of a final order, except that the court may not require the c for good cause shown, order that any health insurance coverage in effect for the child continue in effect pending the rendition of a final order, except that the court may not require the continuation of any health insurance that is not available to the parent at reasonable cost to the obligor. If there is no health insurance coverage in effect for the child or if the insurance in effect is not available at a reasonable cost to the obligor, the court shall, except for good cause shown, order health care coverage for the child as provided under Section 154.182. (d) On rendering a final order the court shall: (1) make specific findings with respect to the manner in which health care coverage is to be provided for the child, in accordance with the priorities identified under Section 154.182; and (2) except for good cause shown or on agreement of the parties, require the parent ordered to provide health care coverage for the child as provided under Section 154.182 to produce evidence to the court's satisfaction that the parent has applied for or secured health insurance or has otherwise taken necessary action to provide for health care coverage for the child, as ordered by the court. (e) In this section, "reasonable cost" means the cost of health insurance coverage for a child that does not exceed nine percent of the obligor's annual resources, as described by Section 154.062(b), if the obligor is responsible under a medical support order for the cost of health insurance coverage for only one child. If the obligor is responsible under a medical support order for the cost of health insurance coverage for more than one child, "reasonable cost" means the total cost of health insurance coverage for all children for which the obligor is responsible under a medical support order that does not exceed nine percent of the obligor's annual resources, as described by Section 154.062(b). for all children for which the obligor is responsible under a medical support order that does not exceed nine percent of the obligor's annual resources, as described by Section 154.062(b). Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 2001, 77th Leg., ch. 449, Sec. 1, eff. June 5, 2001; Acts 2003, 78th Leg., ch. 610, Sec. 1, eff. Sept. 1, 2003. Amended by: Source: Texas Legislature Online (89th Leg., 2nd Called Sess., 2025) Page 1 --- TEXAS FAMILY CODE Chapter 154, Subchapter D — MEDICAL SUPPORT AND DENTAL SUPPORT FOR CHILD Acts 2007, 80th Leg., R.S., Ch. 363 (S.B. 303), Sec. 2, eff. September 1, 2007. Acts 2009, 81st Leg., R.S., Ch. 767 (S.B. 865), Sec. 7, eff. June 19, 2009. Sec. 154.1815. DENTAL SUPPORT ORDER. (a) In this section, "reasonable cost" means the cost of a dental insurance premium that does not exceed 1.5 percent of the obligor's annual resources, as described by Section 154.062(b), if the obligor is responsible under a dental support order for the cost of dental insurance coverage for only one child. If the obligor is responsible under a dental support order for the cost of dental insurance coverage for more than one child, "reasonable cost" means the total cost of dental insurance coverage for all children for which the obligor is responsible under a dental support order that does not exceed 1.5 percent of the obligor's annual resources, as described by Section 154.062(b). (b) In a suit affecting the parent-child relationship or in a proceeding under Chapter 159, the court shall render an order for the dental support of the child as provided by this section and Section 154.1825. (c) Before a hearing on temporary orders, or a final order if no hearing on temporary orders is held, the court shall require the parties to the proceedings to disclose in a pleading or other document whether the child is covered by dental insurance and, if the child is cover mporary orders is held, the court shall require the parties to the proceedings to disclose in a pleading or other document whether the child is covered by dental insurance and, if the child is covered, the identity of the insurer providing the coverage, the policy number, which parent is responsible for payment of any insurance premium for the coverage, whether the coverage is provided through a parent's employment, and the cost of the premium. If dental insurance is not in effect for the child, the parties must disclose to the court whether either parent has access to dental insurance at a reasonable cost to the obligor. (d) In rendering temporary orders, the court shall, except for good cause shown, order that any dental insurance coverage in effect for the child continue in effect pending the rendition of a final order, except that the court may not require the continuation of any dental insurance that is not available to the parent at a reasonable cost to the obligor. If dental insurance coverage is not in effect for the child or if the insurance in effect is not available at a reasonable cost to the obligor, the court shall, except for good cause shown, order dental insurance coverage for the child as provided by Section 154.1825. (e) On rendering a final order the court shall: (1) make specific findings with respect to the manner in which dental insurance coverage is to be provided for the child, in accordance with the priorities identified under Section 154.1825; and (2) except for good cause shown or on agreement of the parties, require the parent ordered to provide dental insurance coverage for the child as provided by Section 154.1825 to produce evidence to the court's satisfaction that the parent has applied for or secured dental insurance or has otherwise taken necessary action to provide for dental insurance coverage for the child, as ordered by the court. Added by Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 14, eff. Septembe has otherwise taken necessary action to provide for dental insurance coverage for the child, as ordered by the court. Added by Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 14, eff. September 1, 2018. Sec. 154.182. HEALTH CARE COVERAGE FOR CHILD. (a) The court shall consider the cost, accessibility, and quality of health insurance coverage available to the parties and shall give priority to health insurance coverage available through the employment of one of the parties if the coverage is available at a reasonable cost to the obligor. (b) In determining the manner in which health care coverage for the child is to be ordered, the court shall render its order in accordance with the following priorities, unless a party shows good cause why a particular order would not be in the best interest of the child: (1) if health insurance is available for the child through a parent's employment or membership in a union, trade association, or other organization at reasonable cost, the court shall order that parent to include the child in the parent's health insurance; (2) if health insurance is not available for the child under Subdivision (1) but is available to a parent at reasonable cost from another source, including the program under Section 154.1826 to provide health insurance in Title IV-D cases, the court may order that parent to provide health insurance for the child; or Source: Texas Legislature Online (89th Leg., 2nd Called Sess., 2025) Page 2 --- TEXAS FAMILY CODE Chapter 154, Subchapter D — MEDICAL SUPPORT AND DENTAL SUPPORT FOR CHILD (3) if health insurance coverage is not available for the child under Subdivision (1) or (2), the court shall order the obligor to pay the obligee, in addition to any amount ordered under the guidelines for child support, an amount, not to exceed nine percent of the obligor's annual resources, as described by Section 154.062(b), as cash medical support for the child. (b-1) If the parent orde elines for child support, an amount, not to exceed nine percent of the obligor's annual resources, as described by Section 154.062(b), as cash medical support for the child. (b-1) If the parent ordered to provide health insurance under Subsection (b)(1) or (2) is the obligee, the court shall order the obligor to pay the obligee, as additional child support, an amount equal to the actual cost of health insurance for the child, but not to exceed a reasonable cost to the obligor. In calculating the actual cost of health insurance for the child, if the obligee has other minor dependents covered under the same health insurance plan, the court shall divide the total cost to the obligee for the insurance by the total number of minor dependents, including the child covered under the plan. (b-2) If the court finds that neither parent has access to private health insurance at a reasonable cost to the obligor, the court shall order the parent awarded the exclusive right to designate the child's primary residence or, to the extent permitted by law, the other parent to apply immediately on behalf of the child for participation in a government medical assistance program or health plan. If the child participates in a government medical assistance program or health plan, the court shall order cash medical support under Subsection (b)(3). (b-3) An order requiring the payment of cash medical support under Subsection (b)(3) must allow the obligor to discontinue payment of the cash medical support if: (1) health insurance for the child becomes available to the obligor at a reasonable cost; and (2) the obligor: (A) enrolls the child in the insurance plan; and (B) provides the obligee and, in a Title IV-D case, the Title IV-D agency, the information required under Section 154.185. (c) In this section: (1) "Accessibility" means the extent to which health insurance coverage for a child provides for the availability of medical care within a reasonable traveling distanc 4.185. (c) In this section: (1) "Accessibility" means the extent to which health insurance coverage for a child provides for the availability of medical care within a reasonable traveling distance and time from the child's primary residence, as determined by the court. (2) "Reasonable cost" has the meaning assigned by Section 154.181(e). (d) Repealed by Acts 2009, 81st Leg., R.S., Ch. 767, Sec. 37, eff. June 19, 2009. Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1997, 75th Leg., ch. 550, Sec. 2, eff. June 2, 1997; Acts 2001, 77th Leg., ch. 449, Sec. 2, eff. June 5, 2001; Acts 2003, 78th Leg., ch. 610, Sec. 2, eff. Sept. 1, 2003. Amended by: Acts 2007, 80th Leg., R.S., Ch. 363 (S.B. 303), Sec. 3, eff. September 1, 2007. Acts 2007, 80th Leg., R.S., Ch. 363 (S.B. 303), Sec. 4, eff. September 1, 2007. Acts 2007, 80th Leg., R.S., Ch. 620 (H.B. 448), Sec. 5, eff. September 1, 2007. Acts 2009, 81st Leg., R.S., Ch. 767 (S.B. 865), Sec. 8, eff. June 19, 2009. Acts 2009, 81st Leg., R.S., Ch. 767 (S.B. 865), Sec. 8, eff. September 1, 2009. Acts 2009, 81st Leg., R.S., Ch. 767 (S.B. 865), Sec. 37, eff. June 19, 2009. Sec. 154.1825. DENTAL CARE COVERAGE FOR CHILD. (a) In this section: (1) "Accessibility" means the extent to which dental insurance coverage for a child provides for the availability of dental care within a reasonable traveling distance and time from the child's primary residence, as determined by the court. (2) "Reasonable cost" has the meaning assigned by Section 154.1815(a). (b) The court shall consider the cost, accessibility, and quality of dental insurance coverage available to the parties and shall give priority to dental insurance coverage available through the employment of one of the parties if the coverage is available at a reasonable cost to the obligor. Source: Texas Legislature Online (89th Leg., 2nd Called Sess., 2025) Page 3 --- TEXAS FAMILY CODE Chapter 154, Subchap if the coverage is available at a reasonable cost to the obligor. Source: Texas Legislature Online (89th Leg., 2nd Called Sess., 2025) Page 3 --- TEXAS FAMILY CODE Chapter 154, Subchapter D — MEDICAL SUPPORT AND DENTAL SUPPORT FOR CHILD (c) In determining the manner in which dental care coverage for the child is to be ordered, the court shall render its order in accordance with the following priorities, unless a party shows good cause why a particular order is not in the best interest of the child: (1) if dental insurance is available for the child through a parent's employment or membership in a union, trade association, or other organization at reasonable cost, the court shall order that parent to include the child in the parent's dental insurance; or (2) if dental insurance is not available for the child under Subdivision (1) but is available to a parent from another source and at a reasonable cost, the court may order that parent to provide dental insurance for the child. (d) If the parent ordered to provide dental insurance under Subsection (c)(1) or (2) is the obligee, the court shall order the obligor to pay the obligee, as additional child support, an amount equal to the actual cost of dental insurance for the child, but not to exceed a reasonable cost to the obligor. In calculating the actual cost of dental insurance for the child, if the obligee has other minor dependents covered under the same dental insurance plan, the court shall divide the total cost to the obligee for the insurance by the total number of minor dependents, including the child covered under the plan. Added by Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 15, eff. September 1, 2018. Sec. 154.1826. HEALTH CARE PROGRAM FOR CERTAIN CHILDREN IN TITLE IV-D CASES. (a) In this section: (1) "Health benefit plan issuer" means an insurer, health maintenance organization, or other entity authorized to provide health benefits coverage under the laws of -D CASES. (a) In this section: (1) "Health benefit plan issuer" means an insurer, health maintenance organization, or other entity authorized to provide health benefits coverage under the laws of this state. (2) "Health care provider" means a physician or other person who is licensed, certified, or otherwise authorized to provide a health care service in this state. (3) "Program" means the child health care program developed under this section. (4) "Reasonable cost" has the meaning assigned by Section 154.181(e). (5) "Third-party administrator" means a person who is not a health benefit plan issuer or agent of a health benefit plan issuer and who provides administrative services for the program, including processing enrollment of eligible children in the program and processing premium payments on behalf of the program. (b) In consultation with the Texas Department of Insurance, the Health and Human Services Commission, and representatives of the insurance industry in this state, the Title IV-D agency shall develop and implement a statewide program to address the health care needs of children in Title IV-D cases for whom health insurance is not available to either parent at reasonable cost under Section 154.182(b)(1) or under Section 154.182(b)(2) from a source other than the program. (c) The director of the Title IV-D agency may establish an advisory committee to consult with the director regarding the implementation and operation of the program. If the director establishes an advisory committee, the director may appoint any of the following persons to the advisory committee: (1) representatives of appropriate public and private entities, including state agencies concerned with health care management; (2) members of the judiciary; (3) members of the legislature; and (4) representatives of the insurance industry. (d) The principal objective of the program is to provide basic health care services, including office visits with health c bers of the legislature; and (4) representatives of the insurance industry. (d) The principal objective of the program is to provide basic health care services, including office visits with health care providers, hospitalization, and diagnostic and emergency services, to eligible children in Title IV-D cases at reasonable cost to the parents obligated by court order to provide medical support for the children. (e) The Title IV-D agency may use available private resources, including gifts and grants, in administering the program. (f) The Title IV-D agency shall adopt rules as necessary to implement the program. The Title IV-D agency shall consult with the Texas Department of Insurance and the Health and Human Services Commission in establishing policies and Source: Texas Legislature Online (89th Leg., 2nd Called Sess., 2025) Page 4 --- TEXAS FAMILY CODE Chapter 154, Subchapter D — MEDICAL SUPPORT AND DENTAL SUPPORT FOR CHILD procedures for the administration of the program and in determining appropriate benefits to be provided under the program. (g) A health benefit plan issuer that participates in the program may not deny health care coverage under the program to eligible children because of preexisting conditions or chronic illnesses. A child who is determined to be eligible for coverage under the program continues to be eligible until the termination of the parent's duty to pay child support as specified by Section 154.006. Enrollment of a child in the program does not preclude the subsequent enrollment of the child in another health care plan that becomes available to the child's parent at reasonable cost, including a health care plan available through the parent's employment or the state child health plan under Chapter 62, Health and Safety Code. (h) The Title IV-D agency shall contract with an independent third-party administrator to provide necessary administrative services for operation of the program. (i) A person acting as afety Code. (h) The Title IV-D agency shall contract with an independent third-party administrator to provide necessary administrative services for operation of the program. (i) A person acting as a third-party administrator under Subsection (h) is not considered an administrator for purposes of Chapter 4151, Insurance Code. (j) The Title IV-D agency shall solicit applications for participation in the program from health benefit plan issuers that meet requirements specified by the agency. Each health benefit plan issuer that participates in the program must hold a certificate of authority issued by the Texas Department of Insurance. (k) The Title IV-D agency shall promptly notify the courts of this state when the program has been implemented and is available to provide for the health care needs of children described by Subsection (b). The notification must specify a date beginning on which children may be enrolled in the program. (l) On or after the date specified in the notification required by Subsection (k), a court that orders health care coverage for a child in a Title IV-D case shall order that the child be enrolled in the program authorized by this section unless other health insurance is available for the child at reasonable cost, including the state child health plan under Chapter 62, Health and Safety Code. (m) Payment of premium costs for the enrollment of a child in the program may be enforced by the Title IV-D agency against the obligor by any means available for the enforcement of a child support obligation, including income withholding under Chapter 158. (n) The program is not subject to any provision of the Insurance Code or other law that requires coverage or the offer of coverage of a health care service or benefit. (o) Any health information obtained by the program, or by a third-party administrator providing program services, that is subject to the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. Section nformation obtained by the program, or by a third-party administrator providing program services, that is subject to the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. Section 1320d et seq.) or Chapter 181, Health and Safety Code, is confidential and not open to public inspection. Any personally identifiable financial information or supporting documentation of a parent whose child is enrolled in the program that is obtained by the program, or by a third-party administrator providing program services, is confidential and not open to public inspection. Added by Acts 2009, 81st Leg., R.S., Ch. 767 (S.B. 865), Sec. 9, eff. June 19, 2009. Sec. 154.1827. ADMINISTRATIVE ADJUSTMENT OF MEDICAL SUPPORT ORDER. (a) In each Title IV-D case in which a medical support order requires that a child be enrolled in a health care program under Section 154.1826, the Title IV-D agency may administratively adjust the order as necessary on an annual basis to reflect changes in the amount of premium costs associated with the child's enrollment. (b) The Title IV-D agency shall provide notice of the administrative adjustment to the obligor and the clerk of the court that rendered the order. Added by Acts 2009, 81st Leg., R.S., Ch. 767 (S.B. 865), Sec. 9, eff. June 19, 2009. Sec. 154.183. MEDICAL AND DENTAL SUPPORT ADDITIONAL SUPPORT DUTY OF OBLIGOR. (a) An amount that an obligor is ordered to pay as medical support or dental support for the child under this chapter, including the costs of health insurance coverage or cash medical support under Section 154.182 and the costs of dental insurance under Section 154.1825: (1) is in addition to the amount that the obligor is required to pay for child support under the guidelines for child support; Source: Texas Legislature Online (89th Leg., 2nd Called Sess., 2025) Page 5 --- TEXAS FAMILY CODE Chapter 154, Subchapter D — MEDICAL SUPPORT AND DENTAL SUPPORT FOR CHILD (2) is a child support exas Legislature Online (89th Leg., 2nd Called Sess., 2025) Page 5 --- TEXAS FAMILY CODE Chapter 154, Subchapter D — MEDICAL SUPPORT AND DENTAL SUPPORT FOR CHILD (2) is a child support obligation; and (3) may be enforced by any means available for the enforcement of child support, including withholding from earnings under Chapter 158. (b) If the court finds and states in the child support order that the obligee will maintain health insurance coverage, dental insurance coverage, or both, for the child at the obligee's expense, the court shall increase the amount of child support to be paid by the obligor in an amount not exceeding the actual cost to the obligee for maintaining the coverage, as provided under Sections 154.182(b-1) and 154.1825(d). (c) As additional child support, the court shall allocate between the parties, according to their circumstances: (1) the reasonable and necessary health care expenses, including vision and dental expenses, of the child that are not reimbursed by health or dental insurance or are not otherwise covered by the amount of cash medical support ordered under Section 154.182; and (2) amounts paid by either party as deductibles or copayments in obtaining health care or dental care services for the child covered under a health insurance or dental insurance policy. Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by: Acts 2007, 80th Leg., R.S., Ch. 363 (S.B. 303), Sec. 5, eff. September 1, 2007. Acts 2007, 80th Leg., R.S., Ch. 620 (H.B. 448), Sec. 6, eff. September 1, 2007. Acts 2009, 81st Leg., R.S., Ch. 87 (S.B. 1969), Sec. 9.002, eff. September 1, 2009. Acts 2009, 81st Leg., R.S., Ch. 767 (S.B. 865), Sec. 10, eff. June 19, 2009. Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 16, eff. September 1, 2018. Sec. 154.184. EFFECT OF ORDER. (a) Receipt of a medical support order requiring that health insurance be provided for a child or a dental support order requiring Sec. 16, eff. September 1, 2018. Sec. 154.184. EFFECT OF ORDER. (a) Receipt of a medical support order requiring that health insurance be provided for a child or a dental support order requiring that dental insurance be provided for a child shall be considered a change in the family circumstances of the employee or member, for health insurance purposes and dental insurance purposes, equivalent to the birth or adoption of a child. (b) If the employee or member is eligible for dependent health coverage or dependent dental coverage, the employer shall automatically enroll the child for the first 31 days after the receipt of the order or notice of the medical support order or the dental support order under Section 154.186 on the same terms and conditions as apply to any other dependent child. (c) The employer shall notify the insurer of the automatic enrollment. (d) During the 31-day period, the employer and insurer shall complete all necessary forms and procedures to make the enrollment permanent or shall report in accordance with this subchapter the reasons the coverage cannot be made permanent. Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 341, Sec. 4.03, eff. Sept. 1, 1995; Acts 1997, 75th Leg., ch. 911, Sec. 11, eff. Sept. 1, 1997. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 17, eff. September 1, 2018. Sec. 154.185. PARENT TO FURNISH INFORMATION. (a) The court shall order a parent providing health insurance or dental insurance to furnish to either the obligee, obligor, or child support agency the following information not later than the 30th day after the date the notice of rendition of the order is received: (1) the social security number of the parent; (2) the name and address of the parent's employer; (3) with regard to health insurance: Source: Texas Legislature Online (89th Leg., 2nd Called Sess., 2025) Page 6 --- TEXAS FAMILY CODE Chapte name and address of the parent's employer; (3) with regard to health insurance: Source: Texas Legislature Online (89th Leg., 2nd Called Sess., 2025) Page 6 --- TEXAS FAMILY CODE Chapter 154, Subchapter D — MEDICAL SUPPORT AND DENTAL SUPPORT FOR CHILD (A) whether the employer is self-insured or has health insurance available; (B) proof that health insurance has been provided for the child; (C) if the employer has health insurance available, the name of the health insurance carrier, the number of the policy, a copy of the policy and schedule of benefits, a health insurance membership card, claim forms, and any other information necessary to submit a claim; and (D) if the employer is self-insured, a copy of the schedule of benefits, a membership card, claim forms, and any other information necessary to submit a claim; and (4) with regard to dental insurance: (A) whether the employer is self-insured or has dental insurance available; (B) proof that dental insurance has been provided for the child; (C) if the employer has dental insurance available, the name of the dental insurance carrier, the number of the policy, a copy of the policy and schedule of benefits, a dental insurance membership card, claim forms, and any other information necessary to submit a claim; and (D) if the employer is self-insured, a copy of the schedule of benefits, a membership card, claim forms, and any other information necessary to submit a claim. (b) The court shall also order a parent providing health insurance or dental insurance to furnish the obligor, obligee, or child support agency with additional information regarding the health insurance coverage or dental insurance coverage not later than the 15th day after the date the information is received by the parent. Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 2001, 77th Leg., ch. 1023, Sec. 10, eff. Sept. 1, 2001. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 arent. Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 2001, 77th Leg., ch. 1023, Sec. 10, eff. Sept. 1, 2001. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 18, eff. September 1, 2018. Sec. 154.186. NOTICE TO EMPLOYER CONCERNING MEDICAL SUPPORT OR DENTAL SUPPORT. (a) The obligee, obligor, or a child support agency of this state or another state may send to the employer a copy of the order requiring an employee to provide health insurance coverage or dental insurance coverage for a child or may include notice of the medical support order or dental support order in an order or writ of withholding sent to the employer in accordance with Chapter 158. (b) In an appropriate Title IV-D case, the Title IV-D agency of this state or another state shall send to the employer the national medical support notice required under Part D, Title IV of the federal Social Security Act (42 U.S.C. Section 651 et seq.), as amended. The notice may be used in any other suit in which an obligor is ordered to provide health insurance coverage for a child. (c) The Title IV-D agency by rule shall establish procedures consistent with federal law for use of the national medical support notice and may prescribe forms for the efficient use of the notice. The agency shall provide the notice and forms, on request, to obligees, obligors, domestic relations offices, friends of the court, and attorneys. Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 341, Sec. 4.04, eff. Sept. 1, 1995; Acts 1997, 75th Leg., ch. 911, Sec. 12, eff. Sept. 1, 1997; Acts 2003, 78th Leg., ch. 120, Sec. 1, eff. July 1, 2003. Amended by: Acts 2007, 80th Leg., R.S., Ch. 972 (S.B. 228), Sec. 12, eff. September 1, 2007. Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 19, eff. September 1, 2018. Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 20, eff. September 1, 2018. Sec. 154.187 September 1, 2007. Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 19, eff. September 1, 2018. Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 20, eff. September 1, 2018. Sec. 154.187. DUTIES OF EMPLOYER. (a) An order or notice under this subchapter to an employer directing that health insurance coverage or dental insurance coverage be provided to a child of an Source: Texas Legislature Online (89th Leg., 2nd Called Sess., 2025) Page 7 --- TEXAS FAMILY CODE Chapter 154, Subchapter D — MEDICAL SUPPORT AND DENTAL SUPPORT FOR CHILD employee or member is binding on a current or subsequent employer on receipt without regard to the date the order was rendered. If the employee or member is eligible for dependent health coverage or dental coverage for the child, the employer shall immediately enroll the child in a health insurance plan or dental insurance plan regardless of whether the employee is enrolled in the plan. If dependent coverage is not available to the employee or member through the employer's health insurance plan or dental insurance plan or enrollment cannot be made permanent or if the employer is not responsible or otherwise liable for providing such coverage, the employer shall provide notice to the sender in accordance with Subsection (c). (b) If additional premiums are incurred as a result of adding the child to the health insurance plan or the dental insurance plan, the employer shall deduct the health insurance premium or the dental insurance premium from the earnings of the employee in accordance with Chapter 158 and apply the amount withheld to payment of the insurance premium. (c) An employer who has received an order or notice under this subchapter shall provide to the sender, not later than the 40th day after the date the employer receives the order or notice, a statement that the child: (1) has been enrolled in the employer's health insurance plan or dental insurance plan, or is already enrolled in a ter the date the employer receives the order or notice, a statement that the child: (1) has been enrolled in the employer's health insurance plan or dental insurance plan, or is already enrolled in another health insurance plan or dental insurance plan in accordance with a previous child support, medical support, or dental support order to which the employee is subject; or (2) cannot be enrolled or cannot be enrolled permanently in the employer's health insurance plan or dental insurance plan and provide the reason why coverage or permanent coverage cannot be provided. (d) If the employee ceases employment or if the health insurance coverage or dental insurance coverage lapses, the employer shall provide to the sender, not later than the 15th day after the date of the termination of employment or the lapse of the coverage, notice of the termination or lapse and of the availability of any conversion privileges. (e) On request, the employer shall release to the sender information concerning the available health insurance coverage or dental insurance coverage, including the name of the health insurance carrier or dental insurance carrier, the policy number, a copy of the policy and schedule of benefits, a health insurance or dental insurance membership card, and claim forms. (f) In this section, "sender" means the person sending the order or notice under Section 154.186. (g) An employer who fails to enroll a child, fails to withhold or remit premiums or cash medical support, or discriminates in hiring or employment on the basis of a medical support order or notice or a dental support order or notice under this subchapter shall be subject to the penalties and fines in Subchapter C, Chapter 158. (h) An employer who receives a national medical support notice under Section 154.186 shall comply with the requirements of the notice. (i) The notices required by Subsections (c) and (d) must be provided to the sender by first class mail, unless the sender is under Section 154.186 shall comply with the requirements of the notice. (i) The notices required by Subsections (c) and (d) must be provided to the sender by first class mail, unless the sender is the Title IV-D agency. Notices to the Title IV-D agency may be provided electronically or via first class mail. Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 341, Sec. 4.05, eff. Sept. 1, 1995; Acts 1997, 75th Leg., ch. 911, Sec. 13, eff. Sept. 1, 1997; Acts 2003, 78th Leg., ch. 120, Sec. 2, eff. July 1, 2003. Amended by: Acts 2009, 81st Leg., R.S., Ch. 767 (S.B. 865), Sec. 11, eff. June 19, 2009. Acts 2011, 82nd Leg., R.S., Ch. 508 (H.B. 1674), Sec. 1, eff. September 1, 2011. Acts 2015, 84th Leg., R.S., Ch. 859 (S.B. 1726), Sec. 4, eff. September 1, 2015. Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 21, eff. September 1, 2018. Sec. 154.188. FAILURE TO PROVIDE OR PAY FOR REQUIRED HEALTH INSURANCE OR DENTAL INSURANCE. A parent ordered to provide health insurance or dental insurance or to pay the other parent additional child support for the cost of health insurance or dental insurance who fails to do so is liable for: Source: Texas Legislature Online (89th Leg., 2nd Called Sess., 2025) Page 8 --- TEXAS FAMILY CODE Chapter 154, Subchapter D — MEDICAL SUPPORT AND DENTAL SUPPORT FOR CHILD (1) necessary medical expenses or dental expenses of the child, without regard to whether the expenses would have been paid if health insurance or dental insurance had been provided; and (2) the cost of health insurance premiums, dental insurance premiums, or contributions, if any, paid on behalf of the child. Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 2001, 77th Leg., ch. 295, Sec. 1, eff. Sept. 1, 2001; Acts 2003, 78th Leg., ch. 610, Sec. 3, eff. Sept. 1, 2003. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 22, eff. Septemb s 2001, 77th Leg., ch. 295, Sec. 1, eff. Sept. 1, 2001; Acts 2003, 78th Leg., ch. 610, Sec. 3, eff. Sept. 1, 2003. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 22, eff. September 1, 2018. Sec. 154.189. NOTICE OF TERMINATION OR LAPSE OF INSURANCE COVERAGE. (a) An obligor ordered to provide health insurance coverage or dental insurance coverage for a child must notify the obligee and any child support agency enforcing a support obligation against the obligor of the: (1) termination or lapse of health insurance coverage or dental insurance coverage for the child not later than the 15th day after the date of a termination or lapse; and (2) availability of additional health insurance or dental insurance to the obligor for the child after a termination or lapse of coverage not later than the 15th day after the date the insurance becomes available. (b) If termination of coverage results from a change of employers, the obligor, the obligee, or the child support agency may send the new employer a copy of the order requiring the employee to provide health insurance or dental insurance for a child or notice of the medical support order or the dental support order as provided by this subchapter. Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1997, 75th Leg., ch. 911, Sec. 14, eff. Sept. 1, 1997. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 23, eff. September 1, 2018. Sec. 154.190. REENROLLING CHILD FOR INSURANCE COVERAGE. After health insurance or dental insurance has been terminated or has lapsed, an obligor ordered to provide health insurance coverage or dental insurance coverage for the child must enroll the child in a health insurance plan or a dental insurance plan at the next available enrollment period. Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 24, eff. September 1, 2018. xt available enrollment period. Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 24, eff. September 1, 2018. Sec. 154.191. REMEDY NOT EXCLUSIVE. (a) This subchapter does not limit the rights of the obligor, obligee, local domestic relations office, or Title IV-D agency to enforce, modify, or clarify the medical support order or dental support order. (b) This subchapter does not limit the authority of the court to render or modify a medical support order or dental support order to provide for payment of uninsured health expenses, health care costs, health insurance premiums, uninsured dental expenses, dental costs, or dental insurance premiums in a manner consistent with this subchapter. Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by: Acts 2009, 81st Leg., R.S., Ch. 767 (S.B. 865), Sec. 12, eff. June 19, 2009. Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 25, eff. September 1, 2018. Sec. 154.192. CANCELLATION OR ELIMINATION OF INSURANCE COVERAGE FOR CHILD. Unless the employee or member ceases to be eligible for dependent coverage, or the employer has eliminated dependent health coverage or dental coverage for all of the employer's employees or members, the employer may not cancel or eliminate coverage of a child enrolled under this subchapter until the employer is provided satisfactory written evidence that: Source: Texas Legislature Online (89th Leg., 2nd Called Sess., 2025) Page 9 --- TEXAS FAMILY CODE Chapter 154, Subchapter D — MEDICAL SUPPORT AND DENTAL SUPPORT FOR CHILD (1) the court order or administrative order requiring the coverage is no longer in effect; or (2) the child is enrolled in comparable insurance coverage or will be enrolled in comparable coverage that will take effect not later than the effective date of the cancellation or elimination of the employer's coverage. Added by Acts 199 insurance coverage or will be enrolled in comparable coverage that will take effect not later than the effective date of the cancellation or elimination of the employer's coverage. Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 341, Sec. 4.06, eff. Sept. 1, 1995. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 26, eff. September 1, 2018. Sec. 154.193. MEDICAL SUPPORT ORDER OR DENTAL SUPPORT ORDER NOT QUALIFIED. (a) If a plan administrator or other person acting in an equivalent position determines that a medical support order or dental support order issued under this subchapter does not qualify for enforcement under federal law, the tribunal may, on its own motion or the motion of a party, render an order that qualifies for enforcement under federal law. (b) The procedure for filing a motion for enforcement of a final order applies to a motion under this section. Service of citation is not required, and a person is not entitled to a jury in a proceeding under this section. (c) The employer or plan administrator is not a necessary party to a proceeding under this section. Added by Acts 1997, 75th Leg., ch. 911, Sec. 15, eff. Sept. 1, 1997. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 27, eff. September 1, 2018. Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 28, eff. September 1, 2018. Source: Texas Legislature Online (89th Leg., 2nd Called Sess., 2025) Page 10