Why Medical and Dental Coverage Should Be Included in a Separation Agreement
                     Why Medical and Dental 
Coverage Should Be 
Included in a Separation 
Agreement
BTL Law Firm
April, 2025
SparationAgreementOntario.ca Page 1
Contents
Medical and Dental Benefits in Separation Agreements ......................................................................... 3
Continued Access to Benefits after Separation ................................................................................... 3
Clarifies Who Pays for Ongoing Coverage ........................................................................................... 3
Health and Dental Care for Children ................................................................................................... 4
Extended Coverage for Former Spouses ............................................................................................. 4
Protecting Both Parties' Financial Interests ........................................................................................ 5
Types of Medical and Dental Benefits Commonly Addressed ................................................................ 
5 Extended Health Insurance ................................................................................................................. 
5
Dental Coverage..................................................................................................................................  6
Mental Health and Counselling Services ............................................................................................. 6
Prescription Drug Coverage and Special Needs Care .......................................................................... 7
Out-of-Pocket Medical and Dental Expenses.......................................................................................... 7
How Ontario Courts View Section 7 Special or Extraordinary Expenses ............................................. 7 
Clarifying Who Pays for Uninsured Expenses ...................................................................................... 8
Detailing Cost-Sharing Percentages .................................................................................................... 8
Common Clauses to Include in Your Separation Agreement .................................................................. 9
Requirement to Maintain Benefits for Children.................................................................................. 9
Reimbursement Process for Uncovered Expenses ............................................................................ 10
Termination Date for Benefits .......................................................................................................... 10
Review and Update Clause................................................................................................................ 10
What Happens if Benefits Are Cancelled or Denied? ........................................................................... 11
Steps to Take if an Employer Discontinues Benefits ......................................................................... 11
Responsibility to Notify and Revise the Agreement .......................................................................... 12 
Alternative Coverage Options ........................................................................................................... 12
The Role of Legal Advice in Protecting Benefits Rights ...................................................................... 13
Reviewing Employer Policies and Health Coverage Options ............................................................. 13 
How a Family Lawyer Can Help ......................................................................................................... 14
Mediation for Benefit-Related Disputes ........................................................................................... 14
Hire Ontario Separation Agreement Lawyer ......................................................................................... 15
Medical and Dental Benefits in Separation Agreements
Continued Access to Benefits after Separation
In many Ontario households, one spouse has access to extended 
health and dental insurance through their employer. Following 
separation, these benefits may still be available to the other
spouse and children, depending on the provider’s policy and the 
nature of the separation.
A separation agreement should clearly state whether the 
spouse with the benefits will continue to maintain the coverage 
for the children, and, if applicable, the former partner. This 
helps avoid misunderstandings and ensures everyone remains 
protected while transitioning to post-separation life.
Clarifies Who Pays for Ongoing Coverage
While a spouse may be willing to keep dependents on their 
employer-sponsored plan, it’s important to determine who will 
cover the cost of premiums or co-payments. A well-drafted 
separation agreement should specify:
 Who is responsible for paying monthly premiums
 Whether the costs will be shared
 How uninsured medical or dental expenses (such as 
orthodontics, physiotherapy, or prescription drugs) will be 
divided
Ontario courts often expect parties to include clear terms 
about Section 7 special or extraordinary expenses, which 
include uninsured medical and dental costs for children.
Health and Dental Care for Children
Children’s well-being should remain a top priority in any 
separation. Including medical and dental benefit 
arrangements in the separation agreement ensures that children 
maintain continuous access to necessary health care services.
This may include regular dental check-ups, vision care, 
counselling, and prescription medications.
Without clear guidelines, disagreements can arise over who is 
responsible for a child’s medical or dental bills, leading to 
unnecessary stress and possible delays in care.
Extended Coverage for Former Spouses
Some benefit plans offer a continuation of coverage for a 
former spouse even after legal separation, at least for a 
transitional period. A separation agreement should identify:
 Whether one spouse agrees to maintain extended 
coverage for the other
 How long the coverage will continue
 What happens if the employed spouse changes jobs or loses 
benefits
Though not legally required, this can be especially helpful 
when one spouse is unemployed, underemployed, or dealing 
with health issues.
Protecting Both Parties' Financial Interests
Health-related costs in Ontario can be significant. By including 
health and dental benefit terms in your separation agreement, 
both parties can prevent future disputes, reduce out-of-pocket 
expenses, and promote transparency. It also makes future court 
enforcement easier, should either party fail to uphold their 
obligations.
Types of Medical and Dental Benefits Commonly 
Addressed
When drafting a separation agreement in Ontario, it’s 
important to go beyond simply stating that benefits will be 
maintained. To avoid confusion or disputes down the line, the 
agreement should specifically outline the types of medical and 
dental benefits that are covered. Here are some of the most 
common types of coverage that should be clearly addressed:
Extended Health Insurance
Extended health benefits typically cover a wide range 
of services not covered by OHIP. These may include:
 Prescription eyeglasses and vision exams
 Physiotherapy and chiropractic care
 Massage therapy and acupuncture
 Medical devices and equipment (e.g., braces, crutches, 
orthotics)
Your separation agreement should outline whether these 
extended services will continue to be provided to children 
and/or a former spouse, and how any costs not covered by the 
plan will be divided.
Dental Coverage
Dental care is a major health consideration, particularly 
for children. Coverage often includes:
 Routine cleanings and exams
 Fillings and tooth extractions
 Orthodontics such as braces
 Major dental procedures and surgeries
To avoid future disagreements, the separation agreement 
should clarify who will maintain dental insurance, what 
procedures are included, and how out-of-pocket expenses will 
be split.
Mental Health and Counselling Services
In today’s world, mental health services are increasingly 
recognised as a vital part of overall well-being. Many extended 
benefit plans offer access to:
 Therapy and psychological counselling
 Social work and mental health assessments
 Addiction counselling or rehab programs
If your child is already attending therapy or will need 
counselling post-separation, your agreement should explicitly 
state how these services will be funded and whether both 
parents will consent to the continuation of care.
Prescription Drug Coverage and Special Needs Care
Prescription drugs can be costly, especially if a child or spouse 
has a chronic illness or special needs. A separation 
agreement should indicate:
 Which parent will provide and pay for prescription drug 
coverage
 How long the coverage will continue
 How exceptional or special medical expenses will 
be shared
This is especially important for families with children 
who require ongoing medications, therapies, or assistive 
care.
Out-of-Pocket Medical and Dental Expenses
How Ontario Courts View Section 7 Special or 
Extraordinary Expenses
Under the Federal Child Support Guidelines—which are 
applied in Ontario family law—certain costs are considered 
Section 7 special or extraordinary expenses. These include 
medical and dental costs that are necessary and reasonable in
relation to the family's means and the child’s best 
interests. Common Section 7 expenses include:
 Orthodontic treatments (e.g., braces)
 Therapy or counselling services
 Prescription medications not covered by a health plan
 Vision care (e.g., glasses, contacts)
 Special needs-related medical equipment or services
Ontario courts often require that these expenses be addressed 
in the separation agreement, either through a fixed percentage
split or an agreement to pay based on each parent’s income.
Clarifying Who Pays for Uninsured Expenses
One of the key benefits of a well-drafted separation agreement 
is that it removes uncertainty. The agreement should clearly 
state:
 Who is responsible for submitting claims to insurance
 Who will cover remaining balances not reimbursed
 Whether both parents must agree to incur certain costs 
in advance
For example, if your child requires braces, therapy, or a 
specialist’s care, and only a portion is reimbursed, the agreement 
should explain how the remainder will be shared.
Detailing Cost-Sharing Percentages
To prevent future conflict, your separation agreement should 
define how uninsured medical and dental expenses will be 
split. The two most common approaches are:
 Equal sharing (50/50): Often used when both parents have 
similar income levels and financial resources.
 Proportional sharing based on income: This method
reflects each parent's ability to pay and is calculated 
based on their gross annual income.
Common Clauses to Include in Your Separation 
Agreement
Here are some common clauses to consider including in your 
separation agreement:
Requirement to Maintain Benefits for Children
Specify whether one or both parents are required to maintain 
extended health and dental benefits for the children. This 
clause should address:
 Which parent will provide primary coverage
 Whether the other parent will maintain secondary 
coverage (if available)
 The obligation to provide proof of coverage and update it
annually
This ensures that children continue to have uninterrupted 
access to care, even if one parent's employment or insurance 
status changes.
Reimbursement Process for Uncovered Expenses
Uninsured medical and dental costs can quickly add up. A 
solid separation agreement should outline:
 How parents will share the cost of these expenses (e.g., 
50/50 or proportional to income)
 A clear reimbursement process, including:
o Timeframes for submitting receipts (e.g., within 
30 days)
o Timeframes for reimbursement (e.g., within 30 days 
of receiving proof)
o Preferred methods of payment (e.g., e-transfer, 
cheque)
Having this process in writing reduces the risk of disputes and 
helps ensure fair and timely contributions from both parents.
Termination Date for Benefits
It’s important to include a clause that outlines when benefit 
obligations will end, such as:
 When the child turns a certain age (commonly 18 or 
25)
 When the child finishes full-time education
 If the child becomes financially independent or 
marries
In cases where a child has special needs or long-term health 
conditions, a continuation clause may be required for 
extended care beyond these milestones.
Review and Update Clause
Benefit plans can change—employers may switch providers, 
modify coverage, or discontinue benefits entirely. Your 
separation agreement should include a review clause that allows 
for:
 Periodic review of benefit-related terms (e.g., annually)
 Renegotiation or updates in the event of:
o Loss of coverage
o Change of employment
o Substantial increase in medical costs
 Agreement on how changes will be discussed or mediated
This clause ensures your agreement remains relevant 
and practical as circumstances evolve.
What Happens if Benefits Are Cancelled or Denied? 
Steps to Take if an Employer Discontinues Benefits 
If the parent providing coverage loses their job, 
changes
employers, or their company discontinues benefits, it’s essential 
to:
 Notify the other parent as soon as possible
 Request formal documentation from the insurer or 
employer confirming the change
 Begin discussions on how to replace or supplement 
coverage, especially if children’s care is affected
This situation often triggers the review clause of your 
separation agreement, prompting both parties to re-evaluate their 
roles and obligations.
Responsibility to Notify and Revise the Agreement
The separation agreement should contain a clause requiring 
either party to notify the other promptly if coverage is lost, 
reduced, or denied. From a legal standpoint, failing to inform 
the other party could result in:
 Breach of agreement
 Uncovered medical costs
 Delays in care for children
Once notified, both parties should work together—ideally with 
legal or mediation support—to revise the agreement. This may 
include reallocating cost responsibilities or finding new 
insurance options.
Alternative Coverage Options
If employer-based benefits are no longer available, there are still 
several ways to ensure continued care:
 Private Insurance Plans: Companies like Blue Cross, 
Manulife, and Sun Life offer family and individual 
health plans that can cover everything from dental and 
prescription drugs to mental health and vision care.
 OHIP+: In Ontario, OHIP+ provides prescription drug 
coverage for eligible children and youth under the age of 
25 who are not covered by a private plan.
 Group Insurance Through Associations: Some
professional or alumni associations offer extended 
health plans for members and their families.
 Low-Income Assistance Programs: Ontario also provides 
health benefit programs for families who qualify based on
income or other needs.
A well-prepared separation agreement should not only account 
for these alternatives but also clarify how costs for new 
coverage will be handled, including shared premiums or 
reallocation of financial responsibility.
The Role of Legal Advice in Protecting Benefits Rights 
Reviewing Employer Policies and Health Coverage Options 
Every extended health and dental insurance plan is different.
Some allow for coverage of a former spouse or dependants 
after separation, while others do not. That’s why it’s vital to:
 Review the specific terms of the benefit plan offered by 
your or your spouse’s employer
 Understand what happens to benefits in the event of job 
loss or policy changes
 Explore alternative health coverage options in 
Ontario,
such as private insurance or OHIP+
A family lawyer can help interpret these policies and ensure 
the separation agreement accurately reflects what is legally 
and practically possible.
How a Family Lawyer Can Help
A qualified Ontario family lawyer plays a critical role in 
drafting, reviewing, and negotiating your separation 
agreement. When it comes to medical and dental benefits, a 
lawyer can:
 Ensure clarity and enforceability of benefit-related 
clauses
 Help determine cost-sharing structures for uninsured 
expenses
 Protect your children’s access to essential care
 Prevent future legal issues by anticipating possible benefit 
disruptions
Lawyers also ensure that the agreement complies with 
the Family Law Act and federal Child Support 
Guidelines, especially when Section 7 expenses are 
involved.
Mediation for Benefit-Related Disputes
In situations where parents disagree about health or dental 
benefits—such as whether braces are necessary or who should 
pay for therapy—family mediation can be an effective, non- 
adversarial solution.
A neutral mediator can help both parties:
 Understand the child’s needs and priorities
 Explore creative solutions that reflect each parent’s 
financial capacity
 Revise the separation agreement when 
circumstances
change
Mediation is often faster, more cost-effective, and less stressful 
than going to court, making it a valuable option for benefit- 
related disputes.
Hire Ontario Separation Agreement Lawyer
Need help? Visit SeparationAgreementOntario.ca or call 
at (647) 254-0909 for expert advice.
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