Health Insurance And Expense Orders

IN THE COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS LAKE COUNTY, OHIO ) ___________________________ ) CASE NO. _________________________ Plaintiff ) -vs- ) JUDGE COLLEEN A. FALKOWSKI ) ____________________________ ) HEALTH INSURANCE AND Defendant EXPENSE ORDERS) ) (A.) Pursuant to ORC 3119.30, the court determines parental responsibility for the health care of the children subject to the child support order as follows: ( ) The obligor shall obtain health insurance for the children through a group policy, contract, or plan offered by obligors employer or through any other group health insurance or health care policy, contract, or plan available to obligor. ( ) The obligee shall obtain health insurance for the children through a group policy, contract, or plan offered by obligees employer or through any other group policy, contract, or plan available to obligee. ( ) Health insurance coverage for the children is not available at a reasonab le cost through a group policy, contract or plan offered by the obligors or obligees employer or through any other group policy, contract or plan available to the obligor or the obligee. Until further order of court, the liability for the cost of medical & health care needs of the children shall be shared between the parties with obligor paying _____% and obligee paying ______% of the childrens medical & health needs. If health insurance coverage for the children becomes hereafter available at a reasonable cost to obligor and/or obligee through a group policy, contract, or plan offered by obligors and/or obligees employer or through any other group policy, contract or plan available to obligor and/or obligee, the obligor and/or obligee to whom tcoverage becomhe es available shall immediately inform the court of that fact by motion. ( ) Both obligor and obligee shall obtain health insurance coverage for the c hildren. (B.) Per ORC 3119.31: (1) If the obligor is required by this order, the obligee is required by this order, or both the obligor and obligee are required by this order, to provide health insurance cover age for the children, whoever is required to obtain health insurance coverage shall: provide the other parent with information regarding the benefits, limitations, and exclusions of the coverage, copies of any Page 1 of 5 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2insurance forms necessary to receive reimbursem, payment ent, or other benefits under the coverage, and a copy of any necessary insurance cards; submit a copy of the child support order issued by this court to the insurer at the time application to enroll the children under the health insurance policy, contract, or plan; furnish written proof to the Child Support Enforcement Agency that this order has been complied with. (2) The court determines the group health insurance policies, contracts, & plans are available at a reasonable cost as follows: To obligor: ___________________________________________(name of insurer) ___________________________________________(name of insurer) To obligee: ___________________________________________(name of insurer) ___________________________________________(name of insurer) (3) The individual who is to be reimsed for out of pocket mbur edical, optical, hospital,dental, or prescription expenses paid for each child who is the subject of the support order is as follows: a) ____________________________________________(name) ____________________________________________(address) ____________________________________________ ____________________________________________(phone #) For the children _____________________________________(name) _____________________________________(name) _____________________________________(name) b) ____________________________________________(name) ____________________________________________(address) ____________________________________________ ____________________________________________(phone #) For the children _____________________________________(name) _____________________________________(name) _____________________________________(name) c) The insurer that provides the health insurance coverage for the a foresaid children may continue making payments for medical, optical, hospital, dental, or prescription services directly to any health care provider in accordance with the applicable health insurance policy, contract, or plan. (4) The obligor and the obligee shall designate the children as covered dependents under any health insurance policy, contract or plan for which they contract. (5) The co-payment or deductible costs required under the health insurance policy, Page 2 of 5 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 3contract, or plan that covers the children shall be divided as follows: obligor shall pay _____ % of same and obligee shall pay ______% of same. (6) The employer of the obligor or obligee required to obtain health insurance coverage is required to release to the other parent or the Child Support Enforcement Agency upon written request any necessary information on the health insurance coverage, including, but not limited to, the name and address of the insurer and the policy, contract, or plan number, to otherwise comply with this order and any court order or notice issued hereafter. (7) The full name and date of birth for each child who is the subject of the child support order is as follows: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ (8) The obligor and the obligee shall com with any requiremply ent described or containedin this order no later than thirty days after the issuance of this order, unless a hearing has been requested pursuant to R.C. 3119.39. (9) If the obligor or obligee is required to obtain health insurance coverage pursuant to the child support order for the children and if the obligor or obligee fails to obtain the health insurance coverage, the Child Support Enforcement Agency shall comply with O.R.C. 3119.43. (10) If the person required to obtain health care insurance coverag e for the children subject to this child support order obtains new employment and the health insurance coverage for the children is provided through the previous employer, the agency shall comply with the requirements of Sections 3119.33 and 3119.34 of the Revised Code which ma