Chapter 5101:12-47 Medical Support

5101:12-47-01 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

5101:12-47-01.1 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

5101:12-47-01.2 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