Chapter 5101:12-47 | Medical Support

Rule 5101:12-47-01 | Medical support definitions.

• Effective: January 15, 2020
• Promulgated Under: 119.03

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 (C)(1) of section 3119.01 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 care coverage" means any medical support that includes health insurance coverage or a public health care plan, payment of costs of premiums, copayments, and deductibles, or payment for medical expenses incurred on behalf of the child subject to the child support order.

(F) "Health insurance coverage" means accessible private health insurance that provides primary care services within thirty miles from the residence of the child subject to the child support order.

(G) "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.

(H) "Health insurance obligor" means a person who is required under a child support order to provide 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.

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

(1) To provide health care coverage for the child subject to the support order;

(2) To provide cash medical support;

(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.

(J) "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.

(K) "Reasonable cost" and "reasonable in cost" means the cost of health insurance coverage to a parent does not exceed five per cent of the annual income of that parent. In applying the five per cent to the cost, the cost is the total actual out-of-pocket cost of a health insurance premium paid or expected to be paid for the coverage.

(L) "Shared responsibility of uncovered healthcare expenses" means the medical support provision established under a 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 the uninsured medical expenses incurred for a child during a calendar year that exceed the total cash medical support amount owed by the parents during that year.

Supplemental Information

Authorized By: 3119.51
Amplifies: 3119.29, 3119.30, 3119.31, 3119.32
Five Year Review Date: 1/15/2025
Prior Effective Dates: 1/1/2007, 3/28/2019

Rule 5101:12-47-02 | Medical support provisions.

• Effective: January 15, 2020
• Promulgated Under: 119.03

(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 group health insurance policies, contracts, or plans to the CSEA. Based on information provided by the parties, the CSEA shall issue medical support provisions in accordance with this rule.

(B) In accordance with division (B) of section 3119.30 of the Revised Code, the obligee is presumed to be the appropriate parent to provide health insurance coverage for the children subject to the child support order, unless rebutted by one of the following:

(1) It is appropriate to order the obligor to provide health insurance coverage when:

(a) The obligor already has health insurance coverage for the children that is reasonable in cost; or

(b) The obligor already has health insurance coverage in place for the children that is not reasonable in cost, but agrees to be named the health insurance obligor and provide coverage under division (A)(2)(a) of section 3119.302 of the Revised Code; or

(c) The obligor can obtain health insurance coverage for the children that is reasonable in cost through an employer or other source. For employer-based coverage, the CSEA shall consider the length of time the obligor has worked with the employer and the stability of the insurance; or

(2) The obligor is the appropriate parent to provide health insurance coverage when the obligee is a non-parent individual or agency that has no duty to provide medical support and the obligor meets one of the conditions listed in paragraph (B)(1) of this rule.

(C) It is appropriate to order both parents to provide health insurance coverage for the children when both parents wish to be named the health insurance obligor and already have health insurance coverage in place or have health insurance coverage available for the children.

(D) Unless the obligee is a non-parent individual or agency that has no duty to provide medical support, when health insurance coverage for the children is not available at reasonable cost to the obligor or obligee at the time the CSEA issues or modifies an order, the order shall specify that the obligee obtain health care coverage for the children not later than thirty days after it becomes available at a reasonable cost, and to inform the CSEA when health care coverage for the children has been obtained.

(E) When the CSEA issues or modifies a child support order, the CSEA shall include a requirement that when health insurance coverage becomes available at a reasonable cost, the obligor shall inform the CSEA and may seek a modification of health care coverage from the court with respect to a court support order, or from the agency with respect to an administrative support order.

(F) Both parents may be ordered to provide health care coverage and pay cash medical support if the obligee is a nonparent individual or agency that has no duty to provide medical support.

(G) 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.

(H) When a child support order is issued or modified, the order shall include a cash medical amount in accordance with rules 5101:12-1-17 and 5101:12-45-10 of the Administrative Code.

(I) In accordance with section 3119.302 of the Revised Code, notwithstanding division (B) of section 3119.29 of the Revised Code, the CSEA may do either of the following:

(1) Permit primary care services to be farther than thirty miles if residents in part or all of the immediate geographic area customarily travel farther distances; or

(2) Require primary care services be accessible by public transportation if public transportation is the obligee's only source of transportation.

(J) When the CSEA makes either accessibility determination in paragraph (I) of this rule, the CSEA shall include this determination in the child support order.

Supplemental Information

Authorized By: 3119.51
Amplifies: 3119.30, 3119.31, 3119.32
Five Year Review Date: 9/24/2024
Prior Effective Dates: 1/1/1998, 10/2/2003