Chapter 5101:12-47 Medical Support

5101:12-47-01 [Effective until 1/1/2015] Medical support provisions.

The following definitions apply throughout division 5101:12 of the Administrative Code:

(A) "Accessible" means that primary care services are located within thirty miles from the residence of the child subject to the child support order. Private health insurance is presumed accessible unless determined inaccessible by a child support enforcement agency (CSEA) during an administrative proceeding, or by a court with jurisdiction over the child support case.

(B) "Cash medical support" has the same meaning as in division (A)(1) of section 3119.29 of the Revised Code.

(C) "Child support order" means either a court child support order or administrative child support order.

(D) "Federal poverty level for an individual" means the official poverty guideline amount for a one-person household, as revised annually in accordance with 42 U.S.C. 9902(2) .

(E) "Health plan administrator" means any entity authorized under Title XXXIX of the Revised Code to engage in the business of insurance in this state, any health insuring corporation, any legal entity that is self-insured and provides benefits to its employees or members, and the administrator of any such entity or corporation.

(F) "Health insurance obligor" means a person who is required under a child support order to provide private health insurance coverage for the child subject to the child support order. The health insurance obligor may be either the custodial parent or caretaker, the non-custodial parent, or both.

(G) "Medical support" means a provision of a support order:

(1) To provide private health insurance coverage for the child subject to the support order that is reasonable in cost and presumed to be accessible, or to report available health insurance coverage;

(2) To provide cash medical support when private health insurance coverage is not available to either party or is not being provided by the health insurance obligor(s) in accordance with the order;

(3) For the shared responsibility of uncovered healthcare expenses; or

(4) That is issued by the court for payment of a specified dollar amount for medical expenses incurred on behalf of the individual subject to the support order.

(H) "Primary care services" means health care services and laboratory services customarily provided by or through a licensed general practitioner, family medicine physician, internal medicine physician, or pediatrician.

(I) "Reasonable cost" and "reasonable in cost" mean:

(1) For a child support order issued or modified before July 21, 2008, employment-related health insurance coverage or other group health insurance, regardless of service delivery mechanism; or

(2) For a child support order issued or modified on or after July 21, 2008, the cost of health insurance to a parent does not exceed five per cent of the annual gross income of the parent. In applying the five per cent to the cost, the cost is the difference between self-only and family coverage.

"Family coverage" means the lowest-cost private health insurance plan that provides coverage for the child(ren) subject to the child support order.

(J) "Shared responsibility of uncovered healthcare expenses" means the medical support provision established under an equitable formula in accordance with section 3119.30 or 3119.32 of the Revised Code for the obligor and obligee to each cover an identified percentage of:

(1) The costs of the healthcare needs of the child subject to the child support order that exceed the amount of cash medical support to be paid when private health insurance coverage is not available to either party; or

(2) The uninsured health care costs or co-payment or deductible costs required under the health insurance policy, contract, or plan that covers the child subject to the child support order when private health insurance coverage is provided in accordance with the order.

Replaces: Part of 5101:12-47-01

Effective: 03/01/2009
R.C. 119.032 review dates: 03/01/2014
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.29 , 3119.30 , 3119.31 , 3119.32
Prior Effective Dates: 1/1/98, 10/2/03, 1/1/07

5101:12-47-01 [Effective 1/1/2015] Medical support provisions.

The following definitions apply throughout division 5101:12 of the Administrative Code:

(A) "Accessible" means that primary care services are located within thirty miles from the residence of the child subject to the child support order. Private health insurance is presumed accessible unless determined inaccessible by a child support enforcement agency (CSEA) during an administrative proceeding, or by a court with jurisdiction over the child support case.

(B) "Cash medical support" has the same meaning as in division (A)(1) of section 3119.29 of the Revised Code.

(C) "Child support order" means either a court child support order or administrative child support order.

(D) "Federal poverty level for an individual" means the official poverty guideline amount for a one-person household, as revised annually in accordance with 42 U.S.C. 9902(2) (10/27/98).

(E) "Health plan administrator" means any entity authorized under Title XXXIX of the Revised Code to engage in the business of insurance in this state, any health insuring corporation, any legal entity that is self-insured and provides benefits to its employees or members, and the administrator of any such entity or corporation.

(F) "Health insurance obligor" means a person who is required under a child support order to provide private health insurance coverage for the child subject to the child support order. The health insurance obligor may be either the custodial parent , the non-custodial parent, or both.

(G) "Medical support" means a provision of a support order:

(1) To provide private health insurance coverage for the child subject to the support order that is reasonable in cost and presumed to be accessible, or to report available health insurance coverage;

(2) To provide cash medical support when private health insurance coverage is not available to either party or is not being provided by the health insurance obligor(s) in accordance with the order;

(3) For the shared responsibility of uncovered healthcare expenses; or

(4) That is issued by the court for payment of a specified dollar amount for medical expenses incurred on behalf of the individual subject to the support order.

(H) "Primary care services" means health care services and laboratory services customarily provided by or through a licensed general practitioner, family medicine physician, internal medicine physician, or pediatrician.

(I) "Reasonable cost" and "reasonable in cost" mean:

(1) For a child support order issued or modified before July 21, 2008, employment-related health insurance coverage or other group health insurance, regardless of service delivery mechanism; or

(2) For a child support order issued or modified on or after July 21, 2008, the cost of health insurance to a parent does not exceed five per cent of the annual gross income of the parent. In applying the five per cent to the cost, the cost is the difference between self-only and family coverage.

"Family coverage" means the lowest-cost private health insurance plan that provides coverage for the child(ren) subject to the child support order.

(J) "Shared responsibility of uncovered healthcare expenses" means the medical support provision established under an equitable formula in accordance with section 3119.30 or 3119.32 of the Revised Code for the obligor and obligee to each cover an identified percentage of:

(1) The costs of the healthcare needs of the child subject to the child support order that exceed the amount of cash medical support to be paid when private health insurance coverage is not available to either party; or

(2) The uninsured health care costs or co-payment or deductible costs required under the health insurance policy, contract, or plan that covers the child subject to the child support order when private health insurance coverage is provided in accordance with the order.

Effective: 1/1/2015
Five Year Review (FYR) Dates: 08/26/2014 and 01/01/2020
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.29 , 3119.30 , 3119.31 , 3119.32
Prior Effective Dates: 1/1/98, 10/2/03, 1/1/07, 3/1/09

5101:12-47-01.1 [Effective until 1/1/2015] Enforcement of order to report private health insurance.

(A) The provisions of this rule only apply to child support orders issued or modified in accordance with section 3119.30 of the Revised Code as adopted under Amended Substitute House Bill 119 of the 127th General Assembly.

(B) A child support order issued or modified pursuant to division (B)(4) of 3119.30 of the Revised Code requires both parties to the child support order to report available private health insurance coverage to the child support enforcement agency (CSEA).

(1) When a CSEA becomes aware that private health insurance coverage for the child may be available to a party and a health insurance obligor has not been established under the child support order, the CSEA shall conduct an investigation to determine whether private health insurance coverage for the child that is reasonable in cost is available.

The CSEA shall use line 7b of the child support computation worksheet from the most recent child support order to determine reasonable cost.

(2) When the CSEA determines that private health insurance coverage for the child that is reasonable in cost is not available, the CSEA shall issue the JFS 04032, "Notice to Provide Cash Medical Support" (8/2008), to both parties, notifying the parties of the determination and that:

(a) The cash medical support obligation and the child support obligation when health insurance is not available shall continue; and

(b) Both parties have a right to request a medical support mistake of fact hearing regarding whether private health insurance coverage for the child that is accessible and reasonable in cost is available to either party.

(3) When the CSEA determines that private health insurance coverage for the child that is reasonable in cost is available, the CSEA shall:

(a) Issue the JFS 04033, "Notice to Provide Private Health Insurance" (8/2008), to both parties, notifying the parties that:

(i) The party to whom the coverage is available is now the health insurance obligor and is ordered to provide the private health insurance coverage for the child;

(ii) The current cash medical support obligation shall cease in accordance with rule 5101:12-47-01.2 of the Administrative Code and the current child support obligation shall be the amount ordered to be paid when health insurance is available; and

(iii) Both parties have a right to request a medical support mistake of fact hearing regarding whether private health insurance coverage for the child that is accessible and reasonable in cost is available to the health insurance obligor;

(b) Issue a copy of the JFS 04033 to the court, when the child support order is a court order;

(c) Issue any modified income withholding or deduction notices necessary when the cash medical support stops; and

(d) Enforce the medical support provision to provide the private health insurance in accordance with rules 5101:12-57-10 to 5101:12-57-10.6 of the Administrative Code.

(C) A child support order issued or modified pursuant to division (B)(1), (B)(2), or (B)(3) of section 3119.30 of the Revised Code requires the health insurance obligor(s) to provide private health insurance that is reasonable in cost and both parties to report available coverage to the CSEA when the coverage is not being provided by the health insurance obligor(s) in accordance with the order.

(1) When a CSEA becomes aware that private health insurance coverage for the child is available to one of the parties and cash medical support is to be paid because coverage is not currently being provided by the health insurance obligor(s) in accordance with the order, the CSEA shall conduct an investigation.

During the investigation, the CSEA shall determine whether private health insurance coverage for the child is available to the party. The CSEA is not required to determine whether the private health insurance coverage is reasonable in cost.

(2) When the CSEA determines that private health insurance coverage for the child is available to the health insurance obligor, the CSEA shall:

(a) Issue the JFS 04031, "Notice Regarding Cash Medical Support Order" (8/2008), to both parties, notifying the parties that:

(i) The health insurance obligor is ordered to provide the private health insurance coverage for the child;

(ii) The current cash medical support obligation shall cease in accordance with rule 5101:12-47-01.2 of the Administrative Code and the current child support obligation shall be the amount ordered to be paid when health insurance is available; and

(iii) Both parties have a right to a request a medical support mistake of fact hearing regarding whether private health insurance coverage for the child that is accessible and reasonable in cost is available to the health insurance obligor(s);

(b) Issue any modified income withholding notices necessary when the cash medical support order stops; and

(c) Enforce the medical support provision to provide the private health insurance in accordance with rules 5101:12-57-10 to 5101:12-57-10.6 of the Administrative Code.

(3) When the CSEA determines that private health insurance coverage for the child is being provided by the other party, the CSEA shall document the coverage in the case record.

(4) When the CSEA determines that private health insurance coverage for the child is not available to either party, the CSEA shall document the findings in the case record and is not required to take any further action.

Effective: 03/01/2009
R.C. 119.032 review dates: 03/01/2014
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.30

5101:12-47-01.1 [Effective 1/1/2015] Medical support provisions for health insurance and uncovered expenses.

(A) In any action or proceeding in which a child support enforcement agency (CSEA) issues or modifies a child support order, each party to the child support order is required to provide a list of any available private group health insurance policies, contracts, or plans to the CSEA.

(B) Based on information provided by the parties in accordance with paragraph (A) of this rule, when the CSEA issues or modifies a child support order, the CSEA shall include one of the following:

(1) A requirement that both the obligor and the obligee obtain private health insurance coverage for the child, if coverage that is reasonable in cost is available to both the obligor and the obligee and dual coverage will provide for coordination of medical benefits without unnecessary duplication of coverage.

(2) A requirement that the obligee obtain private health insurance coverage for the child, if coverage that is reasonable in cost is available through any group policy, contract, or plan available to the obligee and is available at a more reasonable cost than coverage is available to the obligor.

(3) A requirement that the obligor obtain private health insurance coverage for the child, if coverage that is reasonable in cost is available through any group policy, contract, or plan available to the obligor and is available at a more reasonable cost than coverage is available to the obligee.

(4) If private health insurance coverage for the child that is reasonable in cost is not available to the obligor or the obligee at the time that the child support order is issued, a requirement that the obligor and the obligee immediately inform the CSEA administering the child support order when private health insurance coverage for the child becomes available to either the obligor or the obligee.

(C) When a CSEA determines the medical support provision described in paragraph (B) of this rule, the CSEA shall consider any private health insurance in which the obligor, obligee, and/or child are enrolled at the time that the CSEA issues or modifies the child support order.

(D) In accordance with sections 3119.30 and 3119.32 of the Revised Code, in any action or proceeding in which the CSEA is issuing or modifying a child support order, the CSEA shall order or recommend the medical support provision for the shared responsibility of uncovered healthcare expenses.

(E) .

Variations from private health insurance standards for child support orders issued or modified in accordance with section 3119.30 of the Revised Code as adopted under Amended Substitute House Bill 119 of the 127th General Assembly.

(1) When the cost of private health insurance coverage for the child to either parent exceeds five per cent of that parent's annual gross income, the CSEA shall not order that parent to provide the private health insurance coverage for the child that exceeds the reasonable cost standard unless:

(a) Both parents agree that the parent be ordered to provide the private health insurance that exceeds the reasonable cost standard; or

(b) One of the parents requests to be ordered to provide the private health insurance that exceeds the reasonable cost standard.

When the CSEA issues the variation to the reasonable cost standard, the CSEA shall document the variation on the child support order.

(2) A CSEA may extend the thirty-mile accessibility standard for private health insurance when residents in part or all of the immediate geographic area customarily travel farther distances than thirty miles for primary care services. "Immediate geographic area" means the county in which the child resides. When the child's residence is within ten miles of the county line, "immediate geographic area" includes the county in which the child resides and any bordering county.

When the CSEA extends the thirty-mile accessibility standard, the CSEA shall document the variation on the child support order.

(3) A CSEA may expand the accessibility standard to include the requirement that the primary care services must be available by public transportation when the custodial parent or caretaker is dependent upon public transportation.

When the CSEA expands the accessibility standard to include the stipulation described in paragraph (E)(3) of this rule, the CSEA shall document the variation on the child support order.

Effective: 1/1/2015
Five Year Review (FYR) Dates: 08/26/2014 and 01/01/2020
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.30 , 3119.31 , 3119.32
Prior Effective Dates: 1/1/98, 10/2/03, 1/1/07, 3/1/09

5101:12-47-01.2 [Effective until 1/1/2015] Medical support provision for cash medical support.

(A) The CSEA shall calculate the cash medical support amount in accordance with this rule and with the Ohio child support guidelines as described in rule 5101:12-45-10 of the Administrative Code.

(B) In any action or proceeding in which the child support enforcement agency (CSEA) issues or modifies a child support order in accordance with section 3119.30 of the Revised Code as adopted under Amended Substitute House Bill 119 of the 127th General Assembly, the CSEA shall include the medical support provision for the obligor to pay cash medical support during any period in which private health insurance coverage for the child is not available to either party or is not being provided by the health insurance obligor(s) in accordance with the order.

(C) The cash medical support obligation shall:

(1) Commence on the first day of the month following the month in which private health insurance coverage for the child that is provided in accordance with the order is unavailable or terminates.

(2) Cease on the last day of the month immediately preceding the month in which private health insurance coverage for the child that is provided in accordance with the order begins or resumes.

(D) When an obligor has an annual gross income that is less than one hundred fifty per cent of the federal poverty level for an individual, the CSEA shall establish the amount of the cash medical support obligation as zero dollars.

(E) When an obligor has an annual gross income that is one hundred fifty per cent or more of the federal poverty level for an individual, the CSEA shall establish the amount of the cash medical support obligation as the lesser of:

(1) Five per cent of the adjusted gross income of the obligor, or

(2) The amount identified on the JFS 05050, "Schedule of Cash Medical Support Obligations." ( 7/2013).

(F) Cash medical support shall be paid by the obligor through the child support payment central:

(1) To the obligee when the child is not a medicaid recipient.

(2) To the Ohio department of job and family services to defray the cost of medicaid expenditures when the child is a medicaid recipient pursuant to section 3119.30 of the Revised Code and 42 U.S.C. 1396k(a)(1)(A) ( 11/5/1990).

(G) During the period when cash medical support is required to be paid:

(1) The obligor must immediately inform the CSEA when private health insurance coverage for the child becomes available to the obligor, and

(2) The obligee must immediately inform the CSEA when private health insurance coverage for the child becomes available to the obligee.

Effective: 07/01/2013
R.C. 119.032 review dates: 03/01/2014
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.30 , 3119.302
Prior Effective Dates: 3/1/2009

5101:12-47-01.2 [Effective 1/1/2015] Medical support provision for cash medical support.

(A) The child support enforcement agency (CSEA) shall calculate the cash medical support amount in accordance with this rule and with the Ohio child support guidelines as described in rule 5101:12-45-10 of the Administrative Code.

(B) In any action or proceeding in which the CSEA issues or modifies a child support order in accordance with section 3119.30 of the Revised Code as adopted under Amended Substitute House Bill 119 of the 127th General Assembly, the CSEA shall include the medical support provision for the obligor to pay cash medical support during any period in which private health insurance coverage for the child is not available to either party or is not being provided by the health insurance obligor(s) in accordance with the order.

(C) The cash medical support obligation shall:

(1) Commence on the first day of the month following the month in which private health insurance coverage for the child that is provided in accordance with the order is unavailable or terminates.

(2) Cease on the last day of the month immediately preceding the month in which private health insurance coverage for the child that is provided in accordance with the order begins or resumes.

(D) When an obligor has an annual gross income that is less than one hundred fifty per cent of the federal poverty level for an individual, the CSEA shall establish the amount of the cash medical support obligation as zero dollars.

(E) When an obligor has an annual gross income that is one hundred fifty per cent or more of the federal poverty level for an individual, the CSEA shall establish the amount of the cash medical support obligation as the lesser of:

(1) Five per cent of the adjusted gross income of the obligor, or

(2) The amount identified on the JFS 05050, "Schedule of Cash Medical Support Obligations" (effective or revised effective date as identified in rule 5101:12-47-99 of the Administrative Code).

(F) Cash medical support shall be paid by the obligor through the child support payment central:

(1) To the obligee when the child is not a medicaid recipient.

(2) To the Ohio department of job and family services to defray the cost of medicaid expenditures when the child is a medicaid recipient pursuant to section 3119.30 of the Revised Code and 42 U.S.C. 1396k(a)(1)(A) (12/26/13).

(G) During the period when cash medical support is required to be paid:

(1) The obligor must immediately inform the CSEA when private health insurance coverage for the child becomes available to the obligor, and

(2) The obligee must immediately inform the CSEA when private health insurance coverage for the child becomes available to the obligee.

Effective: 1/1/2015
Five Year Review (FYR) Dates: 08/26/2014 and 01/01/2020
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.30 , 3119.302
Prior Effective Dates: 3/1/09, 9/1/12, 7/1/13

5101:12-47-99 [Effective 1/1/2015] Chapter 5101:12-47 form - medical support provisions for cash medical.

The form identified in this rule is referenced within various rules contained within division 5101:12 of the Administrative Code. The effective or revised effective date of the form is as follows:

JFS 05050, "Schedule of Cash Medical Support Obligations"(07/2014).

Effective: 1/1/2015
Five Year Review (FYR) Dates: 01/01/2020
Promulgated Under: 119.03
Statutory Authority: 3125.25
Rule Amplifies: 3125.03