Why Medical and Dental Coverage Should Be Included in a Separation Agreement

1. WhyMedicalandDental CoverageShouldBe IncludedinaSeparation Agreement BTLLaw Firm April,2025 SparationAgreementOntario.ca Page1

2. Contents MedicalandDentalBenefitsinSeparationAgreements......................................................................... 3 ContinuedAccessto Benefitsafter Separation...................................................................................3 ClarifiesWhoPays forOngoing Coverage........................................................................................... 3 HealthandDentalCarefor Children...................................................................................................4 ExtendedCoverageforFormerSpouses............................................................................................. 4 ProtectingBothParties'FinancialInterests........................................................................................5 TypesofMedicaland DentalBenefitsCommonlyAddressed................................................................5 ExtendedHealthInsurance.................................................................................................................5 DentalCoverage..................................................................................................................................6 MentalHealth andCounsellingServices.............................................................................................6 PrescriptionDrugCoverageandSpecialNeedsCare..........................................................................7 Out-of-PocketMedicalandDentalExpenses..........................................................................................7 HowOntarioCourtsViewSection7SpecialorExtraordinaryExpenses.............................................7 ClarifyingWhoPays forUninsuredExpenses......................................................................................8 DetailingCost-SharingPercentages....................................................................................................8 CommonClausestoIncludeinYourSeparation Agreement..................................................................9 RequirementtoMaintainBenefitsfor Children.................................................................................. 9 ReimbursementProcessforUncoveredExpenses............................................................................10 TerminationDateforBenefits..........................................................................................................10 ReviewandUpdateClause................................................................................................................10 WhatHappensif BenefitsAreCancelledorDenied?...........................................................................11 StepstoTakeifanEmployerDiscontinuesBenefits.........................................................................11 ResponsibilitytoNotifyandRevisetheAgreement..........................................................................12 AlternativeCoverageOptions...........................................................................................................12 TheRoleofLegalAdviceinProtectingBenefitsRights......................................................................13 ReviewingEmployerPoliciesandHealth CoverageOptions.............................................................13 HowaFamilyLawyerCan Help.........................................................................................................14 MediationforBenefit-RelatedDisputes...........................................................................................14 HireOntarioSeparationAgreement Lawyer.........................................................................................15

3. MedicalandDentalBenefitsinSeparationAgreements • ContinuedAccesstoBenefitsafterSeparation • InmanyOntariohouseholds,onespousehasaccesstoextended healthanddentalinsurancethroughtheiremployer.Following separation,thesebenefitsmaystillbeavailabletotheother • spouseandchildren,dependingontheprovider’spolicyandthe natureoftheseparation. • Aseparationagreementshouldclearlystatewhether thespousewiththebenefitswillcontinuetomaintainthecoverage forthechildren,and,ifapplicable,theformerpartner.Thishelps avoidmisunderstandingsandensureseveryoneremainsprotectedwhiletransitioningtopost-separationlife. • ClarifiesWhoPaysforOngoingCoverage • Whileaspousemaybe willingtokeepdependentsontheir employer-sponsoredplan,it’simportanttodeterminewhowill coverthecostofpremiumsorco-payments.Awell-drafted separationagreementshouldspecify: • Whoisresponsibleforpayingmonthlypremiums • Whetherthecostswillbeshared • Howuninsuredmedicalordentalexpenses(suchas orthodontics,physiotherapy,orprescriptiondrugs)willbe divided

4. Ontariocourtsoftenexpectpartiestoincludecleartermsabout Section7specialorextraordinaryexpenses,whichinclude uninsuredmedicalanddentalcostsforchildren. • HealthandDentalCareforChildren • Children’s well-beingshouldremainatoppriorityinany separation.Includingmedicalanddentalbenefit arrangementsintheseparationagreementensuresthatchildren maintaincontinuousaccesstonecessaryhealthcareservices. • Thismayincluderegulardentalcheck-ups,visioncare, counselling,andprescriptionmedications. • Withoutclearguidelines,disagreementscanariseoverwhois responsibleforachild’smedicalordentalbills,leadingto unnecessarystressand possibledelaysin care. • ExtendedCoverageforFormerSpouses • Somebenefitplansofferacontinuationofcoverageforaformer spouseevenafterlegalseparation,atleastforatransitional period.Aseparationagreementshouldidentify: • Whetheronespouseagreestomaintainextendedcoverage fortheother • Howlongthecoverage willcontinue • Whathappensiftheemployedspousechangesjobsorloses benefits

5. Thoughnotlegallyrequired,thiscanbeespeciallyhelpfulwhen onespouseisunemployed,underemployed,ordealingwith healthissues. • ProtectingBothParties'FinancialInterests • Health-relatedcostsinOntariocanbesignificant.Byincluding healthanddentalbenefittermsinyourseparationagreement, bothpartiescanpreventfuturedisputes,reduceout-of-pocket expenses,andpromotetransparency.Italsomakesfuturecourt enforcementeasier,shouldeitherpartyfailtoupholdtheir obligations. • TypesofMedicalandDentalBenefitsCommonlyAddressed • WhendraftingaseparationagreementinOntario,it’s importanttogobeyondsimplystatingthatbenefitswillbe maintained.Toavoidconfusionordisputesdowntheline,the agreementshouldspecificallyoutlinethetypesofmedicaland dentalbenefitsthatarecovered.Herearesomeofthemost commontypesofcoveragethatshouldbeclearlyaddressed: • ExtendedHealthInsurance • Extendedhealthbenefitstypicallycoverawiderangeof servicesnotcoveredbyOHIP.Thesemayinclude: • Prescriptioneyeglassesandvisionexams • Physiotherapyandchiropracticcare

6. Massagetherapyandacupuncture • Medicaldevicesandequipment(e.g.,braces,crutches, orthotics) • Yourseparationagreementshouldoutlinewhetherthese extendedserviceswillcontinuetobeprovidedtochildrenand/or aformerspouse, andhowanycostsnotcoveredbytheplanwill bedivided. • DentalCoverage • Dentalcareisamajorhealthconsideration,particularlyfor children.Coverageoftenincludes: • Routinecleaningsandexams • Fillingsandtoothextractions • Orthodonticssuchasbraces • Major dentalproceduresand surgeries • Toavoidfuturedisagreements,theseparationagreementshould clarifywhowillmaintaindentalinsurance,whatproceduresare included,andhowout-of-pocketexpenseswillbesplit. • MentalHealthandCounsellingServices • Intoday’sworld,mentalhealthservicesareincreasingly recognisedasavitalpartofoverall well-being.Manyextended benefitplansofferaccessto: • Therapyandpsychological counselling • Socialworkandmentalhealth assessments • Addictioncounsellingorrehabprograms

7. Ifyourchildisalreadyattendingtherapyorwillneedcounsellingpost-separation,youragreementshouldexplicitly statehowtheseserviceswillbefundedandwhetherbothparents willconsenttothecontinuationofcare. • PrescriptionDrugCoverageandSpecialNeedsCare • Prescriptiondrugscanbecostly,especiallyifachildorspouse hasachronicillnessorspecialneeds.Aseparationagreement shouldindicate: • Whichparentwillprovideandpayforprescriptiondrug coverage • Howlongthecoverage willcontinue • Howexceptionalorspecialmedicalexpenseswillbe shared • Thisisespeciallyimportantforfamilieswithchildrenwho requireongoingmedications,therapies,orassistivecare. • Out-of-PocketMedicalandDentalExpenses • How OntarioCourtsViewSection7Specialor ExtraordinaryExpenses • UndertheFederalChildSupportGuidelines—whichare appliedinOntariofamilylaw—certaincostsareconsidered Section7specialorextraordinaryexpenses.Theseinclude medicalanddentalcoststhatarenecessaryandreasonablein

8. relationtothefamily'smeansandthechild’sbestinterests. CommonSection7expensesinclude: • Orthodontictreatments(e.g.,braces) • Therapyorcounsellingservices • Prescriptionmedicationsnotcoveredbyahealthplan • Visioncare(e.g.,glasses,contacts) • Specialneeds-relatedmedicalequipmentorservices • Ontariocourtsoftenrequirethattheseexpensesbeaddressedin theseparationagreement,eitherthroughafixedpercentage • splitoranagreementtopaybasedoneachparent’sincome. • ClarifyingWhoPaysforUninsuredExpenses • Oneofthekeybenefitsofawell-draftedseparationagreement isthatitremovesuncertainty.Theagreementshouldclearly state: • Whoisresponsibleforsubmittingclaimstoinsurance • Whowillcoverremaining balancesnotreimbursed • Whetherbothparentsmustagreetoincurcertaincostsin advance • Forexample,ifyourchildrequiresbraces,therapy,ora specialist’scare,andonlyaportionisreimbursed,theagreement shouldexplainhowtheremainderwillbeshared. • DetailingCost-SharingPercentages

9. Topreventfutureconflict,yourseparationagreementshould definehowuninsuredmedicalanddentalexpenseswillbe split.Thetwomostcommonapproachesare: • Equalsharing(50/50):Oftenusedwhenbothparentshave similarincomelevelsandfinancialresources. • Proportionalsharingbasedonincome:Thismethod • reflectseachparent'sabilitytopayandiscalculatedbased ontheirgrossannualincome. • CommonClausestoIncludeinYourSeparationAgreement • Herearesomecommonclausestoconsiderincludinginyour separationagreement: • RequirementtoMaintainBenefitsforChildren • Specifywhetheroneorbothparentsarerequiredtomaintain extendedhealthanddentalbenefitsforthechildren.This clauseshouldaddress: • Whichparentwillprovideprimarycoverage • Whethertheotherparentwillmaintainsecondarycoverage (ifavailable) • Theobligationtoprovideproofofcoverageandupdateit • annually • Thisensuresthatchildrencontinuetohaveuninterruptedaccess tocare,evenifoneparent'semploymentorinsurancestatus changes.

10. ReimbursementProcessforUncoveredExpenses • Uninsuredmedicalanddentalcostscanquicklyaddup.Asolid separationagreementshouldoutline: • Howparentswillsharethecostoftheseexpenses(e.g., 50/50orproportionaltoincome) • Aclearreimbursementprocess, including: • Timeframesforsubmittingreceipts(e.g.,within30 days) • Timeframesforreimbursement(e.g.,within30daysof receivingproof) • Preferredmethodsofpayment(e.g.,e-transfer, cheque) • Havingthisprocessinwritingreducestheriskofdisputesand helpsensurefairandtimelycontributionsfrombothparents. • TerminationDateforBenefits • It’simportanttoincludeaclausethatoutlineswhenbenefit obligations willend,suchas: • Whenthechildturnsacertainage(commonly18or25) • Whenthechildfinishesfull-timeeducation • Ifthechildbecomesfinanciallyindependentormarries • Incases whereachildhasspecialneedsorlong-termhealth conditions,acontinuationclausemayberequiredforextended carebeyondthesemilestones. • ReviewandUpdateClause

11. Benefitplanscanchange—employersmayswitchproviders, modifycoverage,ordiscontinuebenefitsentirely.Your separationagreementshouldincludeareviewclausethatallows for: • Periodicreviewofbenefit-relatedterms(e.g.,annually) • Renegotiationorupdatesintheeventof: • Lossofcoverage • Changeofemployment • Substantialincreaseinmedicalcosts • Agreementonhowchanges willbediscussedormediated • Thisclauseensuresyouragreementremainsrelevantand practicalascircumstancesevolve. • WhatHappensifBenefitsAreCancelledorDenied? StepstoTakeifanEmployerDiscontinues Benefits Iftheparentprovidingcoveragelosestheirjob,changes • employers,ortheircompanydiscontinuesbenefits,it’sessential to: • Notifytheotherparentassoonaspossible • Requestformaldocumentationfromtheinsureror employerconfirmingthechange • Begindiscussionsonhowtoreplaceorsupplement coverage,especiallyifchildren’scareisaffected

12. Thissituationoftentriggersthereviewclauseofyourseparationagreement,promptingbothpartiestore-evaluatetheir rolesandobligations. • ResponsibilitytoNotifyandRevisetheAgreement • Theseparationagreementshouldcontainaclauserequiring eitherpartytonotifytheotherpromptlyifcoverageislost, reduced,ordenied.Fromalegalstandpoint,failingtoinformthe otherpartycouldresult in: • Breachofagreement • Uncoveredmedicalcosts • Delaysincareforchildren • Oncenotified,bothpartiesshouldworktogether—ideallywith legalormediationsupport—torevisetheagreement.Thismay includereallocatingcostresponsibilitiesorfindingnew insuranceoptions. • AlternativeCoverageOptions • Ifemployer-basedbenefitsarenolongeravailable,therearestill severalwaystoensurecontinuedcare: • PrivateInsurancePlans:CompanieslikeBlueCross, Manulife,andSunLifeofferfamilyandindividualhealth plansthatcancovereverythingfromdentaland prescriptiondrugstomentalhealthandvisioncare.

13. OHIP+:InOntario,OHIP+providesprescriptiondrug coverageforeligiblechildrenandyouthundertheageof25 whoarenotcoveredbyaprivateplan. • Group InsuranceThrough Associations:Some • professionaloralumniassociationsofferextendedhealth plansformembersandtheirfamilies. • Low-IncomeAssistancePrograms:Ontarioalsoprovides healthbenefitprogramsforfamilieswhoqualifybased on • incomeorotherneeds. • Awell-preparedseparationagreementshouldnotonlyaccount forthesealternativesbutalsoclarifyhowcostsfornew coveragewillbehandled,includingsharedpremiumsor reallocationoffinancialresponsibility. • TheRoleofLegalAdviceinProtectingBenefitsRights ReviewingEmployerPoliciesandHealthCoverageOptions Everyextendedhealthanddentalinsuranceplanisdifferent. • Someallowforcoverageofaformerspouseordependantsafter separation,whileothersdonot.That’swhyit’svitalto: • Reviewthespecifictermsofthebenefitplanofferedby youroryourspouse’semployer • Understandwhathappenstobenefitsintheeventofjob lossorpolicychanges • ExplorealternativehealthcoverageoptionsinOntario, • suchasprivateinsuranceorOHIP+

14. Afamilylawyercanhelpinterpretthesepoliciesandensurethe separationagreementaccuratelyreflectswhatislegallyand practicallypossible. • How aFamilyLawyerCan Help • AqualifiedOntariofamilylawyerplaysacriticalrolein drafting,reviewing,andnegotiatingyourseparationagreement. Whenitcomestomedicalanddentalbenefits,alawyer can: • Ensureclarityandenforceabilityofbenefit-related clauses • Helpdeterminecost-sharingstructuresforuninsured expenses • Protectyourchildren’saccesstoessentialcare • Preventfuturelegalissuesbyanticipatingpossiblebenefit disruptions • Lawyersalsoensurethattheagreementcomplieswiththe FamilyLaw ActandfederalChildSupportGuidelines, especiallywhenSection7expensesareinvolved. • MediationforBenefit-RelatedDisputes • Insituationswhereparentsdisagreeabouthealthordental benefits—suchaswhetherbracesarenecessaryorwhoshould payfortherapy—familymediationcanbeaneffective,non- adversarialsolution. • Aneutralmediatorcanhelpbothparties:

15. Understandthechild’sneedsandpriorities • Explorecreativesolutionsthatreflecteachparent’s financialcapacity • Revisetheseparationagreementwhencircumstances • change • Mediationisoftenfaster,morecost-effective,andlessstressful thangoingtocourt,makingitavaluableoptionforbenefit- relateddisputes. HireOntarioSeparationAgreementLawyer Needhelp?VisitSeparationAgreementOntario.caorcallat (647)254-0909for expertadvice. Downloadfromhere–TemplateofSeparationAgreementFormOntario SeparationAgreementOutline|SeparationAgreementTemplate |SeparationFAQs