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Appendix C ­ Health Insurance Language 3/09

If one of the parties has health insurance: "__________________________ shall provide the primary health insurance for the parties' minor child(ren) so long as the health insurance is available through employment at a reasonable cost as defined in ORC 3119.30. ________________ shall obtain secondary health insurance for the parties' minor child(ren) when it becomes available through employment at a reasonable cost as defined in ORC 3119.30. Upon receipt of the health insurance ___________________________ shall within 14 days of obtaining coverage inform the Child Support Enforcement Agency. In the future, the parties shall, upon receipt of new health insurance information regarding benefits, limitations, and exclusions of the coverage, copies of any insurance forms necessary to receive reimbursement, payment, or other benefits under the coverage, and a copy of any necessary insurance cards provide all updated information to the other party within fourteen (14) days. The parties shall divide all co-pays, deductible costs required under the health insurance policy and all other uncovered health care expenses as follows, father shall pay ______% and mother shall pay ______%. The parties shall provide each other with a copy of all health care bills for the minor child(ren) on a quarterly basis and a summary of all amounts paid by either party. The summary shall include an offset against all cash medical support received. The documentation of health care expenses shall be provided on the last day of the months of March, June, September, and December. Payment/reimbursement for all health care expenses shall be made within thirty (30) days. Absent extraordinary circumstances, motions for payment of health care bills must be made within one (1) year of the date the bills were incurred. The parties shall use all health and dental care providers within the health and dental care plan, unless the parties have entered into a written agreement. Any party who uses a health or dental care provider outside of the health and dental care plan shall solely pay said debt. The only exceptions to this provision are a medical emergency or a health and dental care provider under the plan does not exist in their area. Medical emergency is defined as a life threatening illness or serious injury."

Appendix C ­ Health Insurance Language 3/09

If both of the parties have health insurance: "________________________________ shall provide the primary health insurance for the parties' minor child(ren) so long as the health insurance is available through employment at a reasonable cost as defined in ORC 3119.30. ________________________________ shall provide the secondary health insurance for the parties' minor child(ren) so long as the health insurance is available through employment at a reasonable cost as defined in ORC 3119.30. In the future, the parties shall upon receipt of new health insurance information regarding benefits, limitations, and exclusions of the coverage, copies of any insurance forms necessary to receive reimbursement, payment, or other benefits under the coverage, and a copy of any necessary insurance cards provide all updated information within fourteen (14) days. The parties shall divide all co-pays, deductible costs required under the health insurance policy and all other uncovered health care expenses as follows, father shall pay ______% and mother shall pay ______%. The parties shall provide each other with a copy of all health care bills for the minor child(ren) on a quarterly basis and a summary of all amounts paid by either party. The summary shall include an offset against all cash medical support received. The documentation of health care expenses shall be provided on the last day of the months of March, June, September, and December. Payment/reimbursement for all health care expenses shall be made within thirty (30) days. Absent extraordinary circumstances, motions for payment of health care bills must be made within one (1) year of the date the bills were incurred. The parties shall use all health and dental care providers within the health and dental care plan, unless the parties have entered into a written agreement. Any party who uses a health or dental care provider outside of the health and dental care plan shall solely pay said debt. The only exceptions to this provision are a medical emergency or a health and dental care provider under the plan does not exist in their area. Medical emergency is defined as a life threatening illness or serious injury."

Appendix C ­ Health Insurance Language 3/09

If neither of the parties has health insurance: "Both parties shall provide health insurance for the child(ren) whenever it is available through their employment at a reasonable cost as defined in ORC 3119.30. Upon receipt of the health insurance the party shall within fourteen (14) days of obtaining coverage inform the Child Support Enforcement Agency. In the event either party obtains health insurance, that party shall upon receipt of new health insurance information regarding benefits, limitations, and exclusions of the coverage, copies of any insurance forms necessary to receive reimbursement, payment, or other benefits under the coverage, and a copy of any necessary insurance cards provide all updated information within fourteen (14) days. The parties shall divide all co-pays, deductible costs required under the health insurance policy and all other uncovered health care expenses as follows, father shall pay ______% and mother shall pay ______%. The parties shall provide each other with a copy of all health care bills for the minor child(ren) on a quarterly basis and a summary of all amounts paid by either party. The summary shall include an offset against all cash medical support received. The documentation of health care expenses shall be provided on the last day of the months of March, June, September, and December. Payment/reimbursement for all health care expenses shall be made within thirty days. Absent extraordinary circumstances, motions for payment of health care medical bills must be made within one (1) year of the date the bills were incurred. The parties shall use all health and dental care providers within the health and dental care plan, unless the parties have entered into a written agreement. Any party who uses a health or dental care provider outside of the health and dental care plan shall solely pay said debt. The only exceptions to this provision are a medical emergency or a health and dental care provider under the plan does not exist in their area. Medical emergency is defined as a life threatening illness or serious injury."