Shared Parenting Plan

Supreme Court of Ohio
Uniform Dom estic Relations Form 17
SHARE D PARENTING PL AN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Effecti ve Date: 7/1/2013
Page 7 of 14
B.
Health Insurance Coverage Unavailable to Either Parent
1.
Private health insurance coverage is not accessible and reasonable in cost through a group
policy, contract, or plan to either parent.
2.
If private health insurance coverage becomes available to either parent at reasonable cost,
he/she wi ll im mediately obt ain the insurance, not ify the other paren t and the
County CSEA, and submit to the other parent proof of insurance, insurance forms, and an
insurance card. The CSEA shall determine whether the cost of the insurance is of sufficient
amount to justify an administrative review of the amount of child support payable. In the event
an administrative review is warranted, one shall be conducted.
C.
Division of Uninsured Expenses
1.
The cost of any uninsured medical expenses, incurred by or on behalf of the child(ren) not paid by
a health insurance plan and exceeding $100 per child per year, including co-payments and
deductibles, shall be paid by the parents as follows:
% by Father
% by Mother.
The first $100 per child per year shall be paid by Mother for the following child(ren):
The first $100 per child per year shall be paid by Father for the following child(ren):
Other orders regarding payment of uninsured medical expenses:
2.
The parent incurring the expenses shall provide the other parent the original or copies of all
medical bill s, and Explanation of Benefits (EOB), if available, within 30 days of the date on the bill
or EOB, wh iche ver is lat er, abs ent ex traor d inary circumstances. The other parent shall, within 30
days of receipt of the bill, reimburse the parent incurring the expenses or pay directly to the health
care provider that parent’s percentage share of the bill as shown above.
D.
Other Important Information about Medical Records and Expenses
1.
Each party shall have access to all medical records of the child(ren) as provided by law.
2.
The term “medical expense” or “medical records” shall include but not be limited to medi cal,
dent al, ortho don tic, optical, surgical, hospital, major me dical, psychological, psychiatric,
outpatient, doctor, therapy, counseling, prosthetic, and/or all other expenses/records including
preventative health care expenses/records related to the treatment of the human body and mind.
Page 7/14
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