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A child support order shall contain all of the following:
(A)(1) If the obligor, obligee, or both obligor and obligee, are required under section 3119.30 of the Revised Code to provide health care coverage for the children, a requirement that whoever is required to provide health care coverage provide to the other, not later than thirty days after the issuance of the order, information regarding the benefits, limitations, and exclusions of the coverage, copies of any forms necessary to receive reimbursement, payment, or other benefits under the coverage, and a copy of any necessary proof of coverage;
(2) If the obligor, obligee, or both obligor and obligee, are required under section 3119.30 of the Revised Code to provide health care coverage for the children, a requirement that whoever is required to provide health care coverage provide to the child support enforcement agency, not later than thirty days after the issuance of the order, documentation that verifies that coverage is being provided as ordered.
(B) A statement setting forth the name and address of the individual who is to be reimbursed for medical expenses.
(C) A requirement that a person required to provide health care coverage for the children designate the children as covered dependents under any health care coverage policy, contract, or plan.
(D) A requirement that the obligor, the obligee, or both of them under a formula established by the court, with respect to a court child support order, or the child support enforcement agency, with respect to an administrative child support order, pay extraordinary medical expenses for the children.
(E) A notice that the employer of the person required to obtain health care coverage through that employer is required to release to the other parent, any person subject to an order issued under section 3109.19 of the Revised Code, or the child support enforcement agency on written request any necessary information on the health care coverage, including the name and address of the health plan administrator and any policy, contract, or plan number, and to otherwise comply with this section and any order or notice issued under this section.
(F) A statement setting forth the full name and date of birth of each child who is the subject of the child support order.
(G) A notice that states the following: "If the person required to obtain health care coverage for the children subject to this child support order obtains new employment, the agency shall comply with the requirements of section 3119.34 of the Revised Code, which may result in the issuance of a notice requiring the new employer to take whatever action is necessary to enroll the children in private health care insurance coverage provided by the new employer, when insurance is not being provided by any other source."
COMMON PLEAS COURT MICHELE K. MUMFORD SHELBY COUNTY CLERK CASE # 23DV000055 …
Apr 17, 2023
EMPLOYER: > = = = = to Section 3119.32 ORC. yc 3nforcement Agency (SEA) i address of the insurance com this document (or equivalent original of this document to the TO: Montgomery County Support Enfi P.O. Box 8744 14 West Fourth Street Dayton, Ohio 45401-8744 Obligor has failed to enro employment with us, withix Obligor’s group health inst (date) coverage, employee cos! oe 3. Obligor has terminated empl- New employer's name and < 4, Other reason why medical ins Obligor’s last known…
May 12, 2011
CLOSED
Montgomery County, OH
Jan 11, 2012
DIVORCE WITH CHILDREN
EMPLOYER NU fieicatren—————____ (Obligee) EMPLOYER: ‘0 Section 3119.32 of the Ohio Revised Code_ you are required to release to the Obligor, Obligee or to the Montgomery ~ the health insurance coverage, including, but not limited (giana g ow wos . ‘A Se ny ‘after the occurrence of any of the events listed and mail ale: gb mE nl Be 84 3 wot BEM anos en 38 gag 8 8 owe : Ent 8 t y health insurance plan available by reason of his of this order. company has been changed a…
Montgomery County, OH
Jun 05, 2012
DIVORCE WITH CHILDREN
= = 3 Z = ; i = ? 5 8 = i q a 4 = : EMPLOYER: a gas to Section 3119.32 of the Ohio Revis = 3 ea 6 2 »Montgomery Shild Support Enforcement Agency (S : Hae o =, but not limited = ime and address of the insurance com} g gas a Zz u4o 6 = Bal = 2 ic docomen (or equivatent form) * ue we urrginal of this document to the office and g Far = zm = TO: Montgomery County Support Enforcem Sd go = P.O. Box 8744 3 ag 2S 14 West Fourth Street a5 y= Dayton, Ohio 45401-8744 aaa s ga kas Obligec has failed to enro…
Jun 09, 2011
CLOSED
Montgomery County, OH
Dec 15, 2011
DIVORCE WITH CHILDREN
=o . Ne = et ae = silt S: = EMPLOYER: Bes == op Section 3119.32 ¢ at 3 r ge lild Support Enfor. __ut Ager & LQ SFE the name and address of the ir g + R88 ‘ scree: x E this document (or equivalent f aa ey = ‘iginal of this document to the Fan a EY ‘YU: Montgomery County Support Enfo Bede? P.O. Box 8744 14 West Fourth Street Dayton, Ohio 45401-8744 1 Obligee has failed to enroll « . employment with us, withir 2. Obligee's group health insu (date). cost, if any, etc.) 3. Obligee has terminate…
Jan 20, 2005
CLOSED
Montgomery County, OH
Feb 10, 2012
DIVORCE WITH CHILDREN
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