Health and Dental Benefits After Divorce in Ontario

If you are covered under your spouse's employer plan, a separation or divorce raises a worry fast: will your prescriptions, dental work or glasses still be covered, and what about the children? The answers are mostly found in the plan documents, not in the divorce itself.

This article explains what you can control, where family law connects to the issue, and how to get answers before a date catches you off guard. The details of any plan differ, so confirm yours with the plan administrator and a family lawyer.

Start with the plan, not the court

Employer and group benefit plans set their own rules about who counts as a spouse or dependant, what events end coverage, and whether you can keep coverage by paying for it yourself. Those rules can differ between plans and between insurers. A separation, a divorce order and a new partner may each be treated differently, so do not assume that being married, separated or divorced changes anything on a particular date until the plan confirms it.

If you are the employee who holds the plan, the same applies in reverse. You may have duties under the plan to report changes, and you may have obligations to your spouse or children that exist separately. Speak to a lawyer before you remove anyone from coverage, because doing so while a case is underway can create a dispute.

Dates that matter

A divorce is not final the day the judge signs. A divorce order is effective 31 days after the order was made. The court also will not grant the divorce without the original marriage certificate, though Form 36, the Affidavit for Divorce, can explain why you cannot provide it, and it cannot grant the divorce until the Central Registry of Divorce Proceedings Clearance Certificate has been received.

Divorce also generally requires that the spouses have lived separate and apart for at least one year immediately before the divorce proceeding is determined. You may therefore be separated for some time while still married. Whether your plan treats a separated spouse as covered during that period is a plan question, so ask.

Children's coverage and child support

Before it grants a divorce, the court must satisfy itself that reasonable arrangements have been made for the support of any children of the marriage. On application by either or both spouses, the court may make an order requiring a spouse to pay for the support of any or all children of the marriage. Whether health and dental coverage for the children is addressed in an order or agreement depends on the case, and a lawyer can tell you how it is usually dealt with.

Many parents prefer to settle coverage in a written agreement. Agreements reached through the case conference process are written as Minutes of Settlement. If you have a separation agreement or draft, check that it says who keeps the children on the plan, who pays any premium, and how unplanned costs are shared.

If you need arrangements in place while the case continues, parties commonly ask for temporary orders on child or spousal support. Generally a case conference comes first, with exceptions for urgency and hardship.

Spousal support and the loss of benefits

If you lose coverage you were relying on, that loss may matter to a spousal support discussion. In deciding spousal support, the court considers the condition, means, needs and other circumstances of each spouse, including the length of cohabitation, the functions each performed during cohabitation, and any order, agreement or arrangement relating to support.

Support claims involve sworn financial statements. Form 13 is used for support claims without property or debt claims, and Form 13.1 where property or debt claims are made. They must be sworn or affirmed before a lawyer or commissioner of oaths. Keep records of what you have been spending on prescriptions, dental care and vision so your figures are accurate.

If you receive Guaranteed Income Supplement or other federal benefits, a change in marital status must be reported to Service Canada as soon as possible.

What to do next

• Ask your plan administrator or the employer's human resources team, in writing, what ends coverage for a separated or divorced spouse and for children.
• Ask whether you can continue or convert coverage on your own, and by what deadline.
• Gather your benefits booklet, recent claims history and any upcoming treatment dates.
• Note the divorce order date if you have one, and remember the order takes effect 31 days later.
• Raise coverage for the children in your support discussions or draft agreement.
• Speak to a family lawyer before anyone is removed from a plan during a case.

Frequently asked questions