The moral of this case: draft the language carefully: If the goal is to have a parent provide health insurance for a child to age 26 or as long as permitted under the Affordable Care Act, then the language in an agreement should so specify. If the goal is to have a parent provide health insurance for a child to age 29 or as long as permitted under the Age 29 Law, then the language in an agreement should so specify.
BD v. ED, 2023 NY Slip Op 3971 - NY: Appellate Div., 1st Dept. 2023:
"HIGGITT, J.
Defendant appeals from an order of the Supreme Court, New York County
(Ariel D. Chesler, J.), entered May 24, 2022, which, to the extent
appealed from as limited by the briefs, denied defendant mother's motion
to direct plaintiff father to pay for continued medical insurance
coverage under New York State's Age 29 Law for the parties' eligible
children, to reimburse the daughter for payments already made, and for
counsel fees.
This appeal involves the interplay of the specific language of a
stipulation of settlement and agreement between parties in a matrimonial
action relating to the plaintiff father's obligation to maintain and
pay for health insurance for the parties' adult daughter, and a
14-year-old New York State insurance law — the Age 29 Law (L 2009, ch
240) — that expands access to health insurance for unmarried children of
insureds. The stakes here: whether plaintiff's obligation to maintain
and pay for the daughter's health insurance terminated when she turned
26 years old (when her coverage as a dependent under plaintiff's
employer-subsidized family-health-insurance policy terminated) or
whether that obligation continues through the age of 29 (when her
ability to obtain coverage pursuant to the Age 29 Law ceases). Based on
the clear and unambiguous language chosen by the parties to frame
plaintiff's obligation to maintain and pay for health insurance for the
daughter and the demands of the Age 29 Law, we conclude that plaintiff
is obligated to pay for health insurance coverage that his daughter
obtained pursuant to that law.
I.
The parties married on May 26, 1996, and have two children: a daughter, T.D., and a son, A.D., who is one year younger than T.D.
In June 2013, plaintiff commenced this divorce action. On December 8,
2014, the parties entered into a so-ordered stipulation resolving their
disputes. By a written stipulation of settlement and agreement (the
agreement), effective February 17, 2015, the parties augmented the terms
of the so-ordered stipulation.[1] Article VI of the agreement addresses child support. Section 6.3 is at the center of this appeal.
That provision, which concerns the children's medical insurance and expenses, provides that
"The Children are currently covered under [plaintiff's] medical
insurance (United Healthcare Choice Plus, Health Plan [xxxxx]
xxx-xxxxx-xx, Member ID: xxxxxxxxx, Group Number: xxxxxx). [Plaintiff]
shall keep and maintain for the benefit of the Child such health and
medical insurance plans greater than or equal to the coverage presently
provided by his employer until the latter of (i) each Child is
emancipated pursuant to this Agreement; (ii) each Child is no longer
allowed by law to be covered under a parent's insurance."
At the time the parties entered into the agreement, T.D. was 19 years
old, and was covered as a dependent under the family health insurance
policy (the family policy) plaintiff maintained through his employer,
which the employer subsidized.
The judgment of divorce was entered in May 2015.
II.
In March 2022, when T.D. was 26 years old, defendant sought an order,
among other things, directing plaintiff to maintain and pay for health
insurance for T.D., and to reimburse T.D. for any health insurance
premiums she had paid. Defendant, pointing to § 6.3 of the agreement,
contended that plaintiff was obligated to maintain and pay for T.D.'s
health insurance until she "is no longer allowed by law to be covered
under a parent's insurance"; the Age 29 Law requires health insurers to
provide coverage for an unmarried child of an insured through age 29;
and, therefore, the daughter was allowed by law to be covered under
plaintiff's insurance.[2]
Plaintiff opposed defendant's motion, maintaining that § 6.3 is
ambiguous and that the parties never contemplated that he would be
responsible for the children's health insurance after they turned 26.
Plaintiff asserted that it was customary for a child's health insurance
to end when the child reaches age 26. Twenty-six is not a random number:
under the Affordable Care Act (42 USC § 18001 et seq.), health
insurers are generally required to make health insurance coverage
available to the children of insureds until the children reach age 26.
In opposition to the motion, plaintiff submitted an affidavit
describing the significant financial consequences to him of maintaining
coverage for T.D. pursuant to the Age 29 Law, because his employer would
not subsidize coverage for the daughter pursuant to that law. Plaintiff
also submitted the affidavit of his counsel during the divorce
proceedings, who averred that there were no discussions during his
representation of plaintiff that the obligation to maintain health
insurance for the children would continue after they turned 26. Counsel
further averred that, although the Age 29 Law went into effect in 2009,
approximately six years before the parties entered into the agreement,
neither he nor plaintiff was aware of that law, and that the reference
to the "law" in § 6.3 was to the Affordable Care Act.[3]
Plaintiff also submitted correspondence from an individual in his
employer's human resources department and an individual employed by his
insurer that indicated that, upon turning 26 years old, T.D. was no
longer eligible for coverage under his family plan, although she was
able "to purchase continued coverage" pursuant to the Age 29 Law through
the employer's plan.
In a thorough decision, Supreme Court denied defendant's motion (B.D. v E.D., 75 Misc 3d 828
[Sup Ct, NY County 2022]). The court concluded that the phrase until
"each Child is no longer allowed by law to be covered under a parent's
insurance" in § 6.3 is ambiguous, i.e., is susceptible of more than one
meaning. The court found that the pertinent language of § 6.3 could be
read to require plaintiff to maintain health insurance for T.D. as long
as she is allowed by law to be a dependent under plaintiff's family
plan, which would be until she turns 26. Alternatively, the language
could be read to require plaintiff to maintain health insurance for T.D.
through age 29 pursuant to the Age 29 Law. The court determined that "a
practical and reasonable interpretation of the language is that
[p]laintiff would be obligated to maintain health insurance for the
children so long as they could legally be dependents under his plan" (id.
at 835). Had the parties intended to place on plaintiff the burden of
maintaining health insurance for T.D. pursuant to the Age 29 Law, the
court observed, they could have specified so. Because it found § 6.3
ambiguous, the court considered the affidavits and other extrinsic
evidence, and highlighted plaintiff's matrimonial counsel's averments
that the provision of coverage after a child turned 26 was not
contemplated by the parties.
III.
On her appeal, defendant argues that the agreement unambiguously
required plaintiff to maintain health insurance for T.D. pursuant to the
Age 29 Law because T.D. was allowed by that law to be covered under
plaintiff's insurance. Defendant argues, too, that if the parties
intended to limit plaintiff's obligation under § 6.3 to that imposed by
the Affordable Care Act, they could have referred to that specific law.
Similarly, defendant asserts that plaintiff's obligation under § 6.3 is
not limited to maintaining and paying for coverage for T.D. so long as
she is his dependent. Because the agreement is unambiguous, contends
defendant, consideration of extrinsic evidence, such as the affidavits
submitted by plaintiff and his prior counsel, is not permissible.
Lastly, defendant insists that if the agreement is ambiguous, further
proceedings before the trial court are necessary to ascertain the
meaning of the ambiguous language.
Plaintiff counters that the agreement unambiguously supports his
reading of the document: that plaintiff was not responsible for
maintaining T.D.'s health insurance after she turned 26. Plaintiff
argues that, upon reaching 26 years old, T.D.'s coverage under his
family policy terminated consistent with the requirements of the
Affordable Care Act, and the new policy afforded to T.D. pursuant to the
Age 29 Law was not provided "under [plaintiff's] insurance" within the
meaning of § 6.3. Plaintiff also argues that if the agreement is
ambiguous, his evidence demonstrates that the parties intended to limit
his obligation to maintain health insurance for T.D. until she reached
26. Plaintiff notes that the scope of coverage under T.D.'s policy
pursuant to the Age 29 Law is different from that afforded under his
family policy; that she carries the policy pursuant to the Age 29 Law in
her own name (as opposed to being a dependent on plaintiff's family
policy), and that her policy pursuant to the Age 29 Law costs $1,300 per
month and plaintiff's employer pays no portion of it. Ultimately,
according to plaintiff, the policy pursuant to the Age 29 Law is an
independent policy, not coverage "under [plaintiff's] insurance."
IV.
A stipulation of settlement resolving a matrimonial action is a
contract, and is therefore subject to basic contract interpretation
principles (see Rainbow v Swisher, 72 NY2d 106, 109 [1988]).
A contract is interpreted in accordance with the intent of the
parties and the best evidence of their intent is what they express in
their written agreement (Schron v Troutman Sanders LLP, 20 NY3d 430, 436 [2013]; Greenfield v Philles Records, 98 NY2d 562, 569 [2002]). Clear, unambiguous contractual terms must be enforced according to their plain meaning (Greenfield v Philles Records, 98 NY2d at 569; see Ellington v EMI Music, Inc., 24 NY3d 239, 244 [2014]); when the terms are clear and unambiguous, the court cannot look beyond the four corners of the contract (Ellington v EMI Music, Inc., 24 NY3d at 244; see Kass v Kass, 91 NY2d 554, 566 [1998]).
A contract is unambiguous if, on its face, it is reasonably susceptible of only one meaning (see White v Continental Cas. Co., 9 NY3d 264, 267 [2007]; Greenfield v Philles Records, 98 NY2d at 569-570; see also Ellington v EMI Music, Inc., 24 NY3d at 244).
Whether a contract is ambiguous is determined by examining the entire
agreement and considering the relation of the parties and the
circumstances under which the agreement was entered, with the wording to
be considered in light of the obligation as a whole and the intention
of the parties manifested thereby (see Kass v Kass, 91 NY2d at 566). A court should not strain to find an ambiguity in contractual terms (see Uribe v Merchants Bank of N.Y., 91 NY2d 336, 341 [1998]).
The language at the center of the parties' dispute — "each Child is
no longer allowed by law to be covered under [plaintiff's] insurance" —
contains two separate phrases that have engendered controversy in this
litigation. The first is "allowed by law," and the second is "covered
under [plaintiff's] insurance."
With regard to the first phrase, in light of the context of the
agreement as a whole, the meaning of that phrase is clear and
unambiguous: plaintiff must maintain and pay for health insurance for
T.D. so long as any relevant law permits coverage. To limit the law or
laws applicable in § 6.3 would distort the meaning of the phrase
"allowed by law" (see Consedine v Portville Cent. School Dist., 12 NY3d 286, 293 [2009]).
If the parties, both of whom were represented by counsel at all
relevant times, wanted plaintiff's obligation under § 6.3 to be tied to
or controlled by any particular law or laws, they could have specified
the normative authority that defined plaintiff's duties. They chose not
to do so. Relatedly, if plaintiff wanted to limit his § 6.3 obligation,
he could have bargained for express limitations; he opted to assent to
broad terms.
As disclosed above, two relevant laws have been identified by the
parties that inform the meaning of § 6.3: the federal Affordable Care
Act and New York's Age 29 Law.
As observed by Supreme Court (and the parties do not dispute),
"[u]nder the Affordable Care Act, effective September 23, 2010, plans
and insurers that offer coverage to children on their parents' plan were
required to make the coverage available until the adult child reaches
the age of 26" (75 Misc 3d at 830 [internal citation omitted]).
New York's Age 29 Law, which was effective approximately one year
before the Affordable Care Act, amended various sections of the State's
Insurance Law to "expand[] access to health insurance by allowing
unmarried children through age 29, regardless of financial dependence, to be covered under a parent's group health insurance policy" (Assembly Mem in Support, Bill Jacket, 2009, ch 240, Purpose [emphasis added]).[4]
Specifically, the Age 29 Law "expands access to health insurance
through a COBRA-like benefit for young adults by requiring commercial
insurers, non-profit corporations and HMOs to offer an option to continue coverage for unmarried young adults through age 29, regardless of financial dependence, under a parent's group health insurance policy" (id., Statement of Purpose [emphasis added]).[5]
Pursuant to the Age 29 Law, a parent's health insurance serves as the
basis for coverage for an eligible adult child who has otherwise aged
off of the parent's policy.
While T.D., upon turning 26 years old, was no longer able to obtain
health insurance pursuant to the Affordable Care Act, T.D. was able to
(and did) obtain health insurance pursuant to the Age 29 Law.[6]
That is to say, owing to the Age 29 Law, T.D., by virtue of the fact
that plaintiff has health insurance through his employer, was "allowed
by law" to obtain health insurance coverage under plaintiff's insurance.
Plaintiff's contention that the parties needed to specify that
plaintiff's obligation was tied to the Age 29 Law because that law is
"unique" is without merit. That the Age 29 Law may be "unique" is
irrelevant; however one chooses to characterize that law, it is no less a
"law" under § 6.3.
The second § 6.3 phrase at issue — "covered under [plaintiff's]
insurance" — is similarly clear and unambiguous. That phrase, read in
light of the context of the agreement as a whole, plainly refers to
health insurance coverage under plaintiff's employer's medical insurance
plan (or such other insurance plan under which plaintiff obtains health
insurance coverage). Like the agreement's reference to the "law," the
reference to "a parent's insurance" is broad, and unrestricted by any
particular qualifier (such as a specific policy or type of policy).[7]
Reading the phrase "under [plaintiff's] insurance" to mean health
insurance coverage under plaintiff's employer's health insurance plan is
consistent with § 6.6, which provides that, "[i]n the event that
[plaintiff] is no longer able to maintain health insurance coverage for
the benefit of the child through his employer or subsequent employer,
[plaintiff] agrees that he shall be 100% responsible for securing and
paying for the continued coverage of comparable health insurance, for
the benefit of the children, for as long as required hereunder [see
§ 6.3]." Clearly the parties contemplated that plaintiff might not be
able to maintain health insurance for T.D. under the family plan, and
they planned for that contingency, requiring plaintiff to maintain
health insurance for T.D. "greater than or equal to the coverage
presently provided by his employer [under the family plan]" (§ 6.3) and
to be "100% responsible for securing and paying for the continued
coverage of comparable health insurance" (§ 6.6) (see Nomura Home Equity Loan, Inc., Series 2006-FM2 v Nomura Credit & Capital, Inc., 30 NY3d 572, 581 [2017]
[court should read a contract as a harmonious and integrated whole]).
To read "under [plaintiff's] insurance" in § 6.3 to mean "under
[plaintiff's family plan]" would leave § 6.6 with little to no force (see Two Guys from Harrison-N.Y., Inc. v S.F.R Realty Assoc., 63 NY2d 396, 403 [1984]).
Ultimately, the practical and reasonable interpretation of § 6.3 is
that, to the extent plaintiff can maintain health insurance for T.D.
through his employer, he is required to do so as long as any relevant
law permits coverage for T.D. As he acknowledges in his brief (and as
the evidence he submitted in opposition to the motion establishes), T.D.
has coverage under the same health insurance plan provided by
plaintiff's employer to its employees. Thus, by virtue of the fact that
plaintiff has health insurance through his employer, Age 29 Law coverage
is available to T.D.
Because the agreement is clear and unambiguous, reference to extrinsic evidence is not permissible (see Consedine v Portville Cent. School Dist., 12 NY3d at 293). We note that extrinsic evidence cannot be used to cast doubt on the meaning of clear and unambiguous contractual terms (see Brad H. v City of New York, 17 NY3d 180, 186 [2011]).
Moreover, that one party attaches a particular, subjective meaning to a
term or phrase that differs from the term's or phrase's plain meaning
does not render the term or phrase ambiguous (see Moore v Kopel, 237 AD2d 124, 125 [1st Dept 1997]; see also Vesta Capital Mgt. LLC v Chatterjee Group, 78 AD3d 411, 411 [1st Dept 2010]).
While plaintiff complains of the costs associated with a policy
provided pursuant to the Age 29 Law and points out that, consistent with
that law, his employer does not subsidize any portion of those costs,
we enforce the plain language of the agreement regardless of any
economic hardship that plaintiff may encounter (see JFK Holding Co. v City of New York, 21 NY3d 722, 728 [2013]).
Of course, we may not rewrite the plain contractual language in an
effort to right some perceived inequity in the parties' bargain (see Greenfield v Philles Records, 98 NY2d at 570 ["a court is not free to alter the contract to reflect its personal notions of fairness and equity"]).
In light of our determination that the aspects of defendant's motion
seeking to compel plaintiff to pay for T.D.'s coverage pursuant to the
Age 29 Law and to reimburse T.D. for any payments she has made for such
coverage should be granted, we remand the matter to Supreme Court to
consider anew that aspect of defendant's motion seeking attorneys' fees.
Accordingly, the order of the Supreme Court, New York County (Ariel
D. Chesler, J.), entered May 24, 2022, which, to the extent appealed
from as limited by the briefs, denied defendant mother's motion to
direct plaintiff father to pay for continued medical insurance coverage
under New York State's Age 29 Law for the parties' eligible children, to
reimburse the daughter for payments already made, and for counsel fees,
should be modified, on the law, to grant defendant's motion to the
extent of directing plaintiff to pay for Age 29 Law health insurance for
the parties' daughter, T.D., until she is no longer eligible for
coverage pursuant to that law, and to reimburse T.D. for payments she
has made for such coverage, the matter remanded for further proceeding
consistent with this decision and order, and otherwise affirmed, without
costs.
Order, Supreme Court, New York County (Ariel D. Chesler, J.), entered
May 24, 2022, which, to the extent appealed from as limited by the
briefs, denied defendant mother's motion to direct plaintiff father to
pay for continued medical insurance coverage under New York State's Age
29 Law for the parties' eligible children, to reimburse the daughter for
payments already made, and for counsel fees, modified, on the law, to
grant defendant's motion to the extent of directing plaintiff to pay for
Age 29 Law health insurance for the parties' daughter, T.D., until she
is no longer eligible for coverage pursuant to that law, and to
reimburse T.D. for payments she has made for such coverage, the matter
remanded for further proceeding consistent with this decision and order,
and otherwise affirmed, without costs.
All concur.
THIS CONSTITUTES THE DECISION AND ORDER OF THE SUPREME COURT, APPELLATE DIVISION, FIRST DEPARTMENT.
[1] The agreement was incorporated in but not merged into the judgment of divorce.
[2]
Additionally, defendant wanted the order to direct plaintiff to secure
health insurance pursuant to the Age 29 Law for A.D., if and when he is
eligible for the benefits of that law. Because A.D.'s eligibility for
coverage pursuant to the Age 29 Law have neither been conceded by the
parties nor established by the record adduced before the motion court,
we do not pass upon whether plaintiff has any obligation to maintain and
pay for health insurance for A.D. pursuant to that law.
[3]
Plaintiff cross-moved for counsel fees and costs. The cross-motion was
denied, and plaintiff did not appeal from that determination.
[4]
The Age 29 Law amended, among other provisions, Insurance Law §§ 3216
(commercial insurers providing individual health insurance policies),
3221 (commercial insurers providing group health insurance policies),
and 4304 and 4305 (not-for-profit corporations and HMOs) to require that
the age 29 option be made available to the relevant individuals.
[5]
With respect to commercial insurers that provide group health
insurance coverage, the legislation aimed to provide "an option to
continue coverage to unmarried children who have `aged off' of their
parents' group health insurance policies. The `dependent children' may
continue to be covered under their parents' group policy through age 29"
(id., Summary of Provisions).
[6]
To qualify for a policy pursuant to the Age 29 Law, the unmarried
child must live, work or reside in New York State, and must not be
insured or eligible for coverage under any employer-sponsored insurance
offered by the child's employer (id., Summary of Provisions).
[7]
Plaintiff notes that § 6.3 opens with an express reference to his
family plan and, therefore, the parties expressed their intention that
his obligation was limited to providing T.D. coverage under that
particular policy. That reference was to the policy under which the
children were then "currently" covered; the remainder of § 6.3 and §§
6.4 and 6.6 make plain that plaintiff's obligation was not linked to any
particular policy."