Medical Support in Outgoing Cases to Canada


Publication Date: August 7, 2019



DATE:  August 7, 2019

TO:  State and Tribal IV-D Directors

SUBJECT:  Medical Support in Outgoing Cases to Canada

Dear Colleague:

Recently Canada has raised the issue of requests for medical insurance coverage that often accompany applications from U.S. child support agencies. In Canada it is not possible to add a child who resides in the United States to a medical insurance policy of a Canadian resident. However, it is possible for a court to order a Canadian obligor to contribute toward these items:

  • Insurance premiums for the child in the United States, or
  • Specific health-related expenses not covered by insurance, including orthodontic treatment; professional counseling provided by a clinical social worker, psychologist, or psychiatrist; physiotherapy; occupational therapy; speech therapy; medications; hearing aids; glasses; and contact lenses.

To request specific contributions for insurance premiums or health-related expenses, the application must include the following:

  • Documentary evidence to prove the amount of the health insurance premiums, specifying the amount designated for the child’s coverage
  • Documentary evidence to prove the amount of the specific health-related expenses that exceed insurance reimbursement by at least $100 annually
  • Proof of the obligee petitioner’s income (such as income tax information or recent pay stubs).

In order to avoid case processing delays, we remind you of information on page 7 of A Caseworker’s Guide for Processing Cases with Canada, which you can find in the Canada section of the OCSE international website:

Medical Support

The child support guidelines in most provinces and territories include a provision that permits the court to order amounts to cover specific expenses over and above the guideline table amount. One category of these special additional expenses is health-related expenses, or any portion of health-related expenses, not covered by insurance, that exceed $100 annually. In determining an amount for health-related expenses, the court may take into account any amount either parent must pay for medical or dental insurance coverage for the child. The Canadian court may therefore order the obligor to pay specified amounts towards the cost of medical insurance for the child. In order for the court to order medical support, the application must include clear documentary proof of health-related expenses. The application must also include proof of the obligee petitioner's income because all additional amounts ordered to be contributed to special expenses, such as health-related expenses, are determined based on proportional sharing of the expense based on the parties' incomes.

If you have any questions or comments, please contact


Scott M. Lekan
Office of Child Support Enforcement

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