Chapter 5101:12-57 Medical Support Provisions

5101:12-57-01 Enforcement of medical support provisions.

(A) The rules in Chapter 5101:12-57 of the Administrative Code describe the responsibility of a child support enforcement agency (CSEA) to enforce the medical support provisions that are contained in a child support order.

(B) Throughout division 5101:12 of the Administrative Code, "Consumer Credit Protection Act" means the federal wage garnishment law in accordance with 15 U.S.C. 1673(b) (11/6/1978) that limits the amount of an employee's earnings that may be garnished in any one week.

(C) Fully subsidized medicaid does not satisfy the requirement of the health insurance obligor to provide private health insurance coverage for a child under a child support order.

(D) In accordance with section 3119.43 of the Revised Code, when a health insurance obligor does not obtain the required private health insurance coverage within thirty days after the child support order or the JFS 04033, "Notice to Provide Private Health Insurance" (8/2008), is issued, the CSEA shall notify the court that issued the child support order or, with respect to an administrative child support order, the court of common pleas of the county in which the CSEA is located, in writing of the failure of the health insurance obligor to comply with the child support order.

R.C. 119.032 review dates: 12/22/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.30 , 3119.43 , 3119.44
Prior Effective Dates: 1/7/85, 8/1/86, 12/1/87, 12/20/88, 9/1/89, 8/1/90, 6/1/91, 11/1/91, 7/15/92, 4/1/93, 1/1/98, 10/2/03, 1/1/07, 3/1/09

5101:12-57-01.1 [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 section 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

5101:12-57-01.1 [Effective 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 section 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" ( effective or revised effective date as identified in rule 5101:12-57-99 of the Administrative Code), 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" ( effective or revised effective date as identified in rule 5101:12-57-99 of the Administrative Code), 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"

( effective or revised effective date as identified in rule 5101:12-57-99 of the Administrative Code), 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: 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
Prior Effective Dates: 3/1/09

5101:12-57-01.2 [Effective until 1/1/2015] Enforcement of cash medical support obligation.

(A) This rule describes the requirements of the child support enforcement agency (CSEA) during any period in which an obligor is ordered to pay cash medical support because private health insurance coverage for the child as ordered is no longer available to the health insurance obligor.

(B) The provisions of this rule only apply to child support orders issued or modified in accordance with division (B)(1), (B)(2), or (B)(3) of section 3119.30 of the Revised Code as adopted under Amended Substitute House Bill 119 of the 127th General Assembly.

(C) When a CSEA determines that private health insurance coverage for the child is no longer being provided by the health insurance obligor(s) in accordance with the order, the CSEA shall:

(1) Issue the JFS 04032, "Notice to Provide Cash Medical Support" (8/2008), to both parties of the child support order, notifying the parties that:

(a) The obligor shall pay the current cash medical support obligation and the current child support obligation ordered to be paid when health insurance is not available;

(b) When private health insurance is available to either party, the party to whom the coverage is available is required to immediately inform the CSEA of the coverage; and

(c) 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(s); and

(2) Issue any modified income withholding or deduction notices necessary.

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

5101:12-57-01.2 [Effective 1/1/2015] Enforcement of cash medical support obligation.

(A) This rule describes the requirements of the child support enforcement agency (CSEA) during any period in which an obligor is ordered to pay cash medical support because private health insurance coverage for the child as ordered is no longer available to the health insurance obligor.

(B) The provisions of this rule only apply to child support orders issued or modified in accordance with division (B)(1), (B)(2), or (B)(3) of section 3119.30 of the Revised Code as adopted under Amended Substitute House Bill 119 of the 127th General Assembly.

(C) When a CSEA determines that private health insurance coverage for the child is no longer being provided by the health insurance obligor(s) in accordance with the order, the CSEA shall:

(1) Issue the JFS 04032, "Notice to Provide Cash Medical Support" ( effective or revised effective date as identified in rule 5101:12-57-99 of the Administrative Code), to both parties of the child support order, notifying the parties that:

(a) The obligor shall pay the current cash medical support obligation and the current child support obligation ordered to be paid when health insurance is not available;

(b) When private health insurance is available to either party, the party to whom the coverage is available is required to immediately inform the CSEA of the coverage; and

(c) 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(s); and

(2) Issue any modified income withholding or deduction notices necessary.

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
Prior Effective Dates: 3/1/09

5101:12-57-08 [Effective until 1/1/2015] Medical support mistake of fact hearing process.

(A) Purpose.

This rule describes the medical support mistake of fact hearing process.

(B) Availability.

The medical support mistake of fact process is only available to an individual whose child support order was 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.

(C) Request for medical support mistake of fact hearing.

An obligor or obligee may submit a request for a medical support mistake of fact hearing to contest the child support enforcement agency's (CSEA) determination regarding whether private health insurance coverage that is accessible and reasonable in cost is available to:

(1) The health insurance obligor(s); or

(2) Either party to the child support order, when a health insurance obligor has not been identified.

(D) The party must file the request for the medical support mistake of fact hearing with the CSEA within seven business days of the date that the CSEA issues a:

(1) JFS 04031, "Notice Regarding Cash Medical Support Order" (8/2008);

(2) JFS 04032, "Notice to Provide Cash Medical Support" (8/2008); or

(3) JFS 04033, "Notice To Provide Private Health Insurance" (8/2008).

(E) Scheduling the medical support mistake of fact hearing.

The CSEA shall:

(1) Schedule the medical support mistake of fact hearing to be held on a date that is no later than ten days after the date the request was received; and

(2) Issue a JFS 07053, "Notice of Medical Support Mistake of Fact Hearing" (8/2008), to both parties no later than five days before the date that the medical support mistake of fact hearing is scheduled to be conducted.

(F) Denying a medical support mistake of fact hearing.

When denying a request for a medical support mistake of fact hearing, the CSEA shall issue a JFS 07058, "Medical Support Mistake of Fact Hearing Determination" (8/2008), that includes the reason for the denial to the requesting party within fourteen days of the date that the requesting party filed the request with the CSEA.

A CSEA may deny a request for a medical support mistake of fact hearing when:

(1) The request is not timely filed.

(2) The request is for a reason other than to contest whether:

(a) Private health insurance that is accessible and reasonable in cost is or is not being provided in accordance with the order, when at least one of the parties has been identified as the health insurance obligor; or

(b) Private health insurance that is accessible and reasonable in cost is or is not available to either party, when neither party has been identified as the health insurance obligor.

(3) The request is not submitted by the obligor, the obligor's representative, or the obligee or the obligee's representative.

(G) Conducting the medical support mistake of fact hearing.

(1) No later than the scheduled date of the hearing, the parties may provide the CSEA with any evidence or relevant information necessary for the CSEA to properly review whether private health insurance coverage that is accessible and reasonable in cost is available to:

(a) The health insurance obligor(s); or

(b) Either party, when a health insurance obligor has not been identified.

(2) At the medical support mistake of fact hearing, the CSEA shall:

(a) Review the information that led to the issuance of the JFS 04031, JFS 04032, or JFS 04033;

(b) Consider any testimony or evidence submitted by either party or received independently from another source that is relevant to the issues to be addressed; and

(c) Determine whether private health insurance coverage that is accessible and reasonable in cost is available to:

(i) The health insurance obligor(s); or

(ii) Either party, when a health insurance obligor has not been identified.

(H) Medical support mistake of fact determination.

(1) No later than fourteen days from the date of the medical support mistake of fact hearing, the CSEA shall:

(a) Issue a JFS 07058 to both parties.

(b) Record the results of the medical support mistake of fact hearing in and make any necessary changes to the support enforcement tracking system based on the results of the hearing.

(2) Each party has the right to file for a court hearing to object to the determination made by the CSEA within seven business days of the date that the CSEA issues the JFS 07058.

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

5101:12-57-08 [Effective 1/1/2015] Medical support mistake of fact hearing process.

(A) This rule describes the medical support mistake of fact hearing process which is only available to an individual whose child support order was 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) An obligor or obligee may submit a request for a medical support mistake of fact hearing to contest the child support enforcement agency's (CSEA) determination regarding whether private health insurance coverage that is accessible and reasonable in cost is available to:

(1) The health insurance obligor(s); or

(2) Either party to the child support order, when a health insurance obligor has not been identified.

(C) The party must file the request for the medical support mistake of fact hearing with the CSEA within seven business days of the date that the CSEA issues either a:

(1) JFS 04031, "Notice Regarding Cash Medical Support Order" (effective or revised effective date as identified in rule 5101:12-57-99 of the Administrative Code);

(2) JFS 04032, "Notice to Provide Cash Medical Support" (effective or revised effective date as identified in rule 5101:12-57-99 of the Administrative Code); or

(3) JFS 04033, "Notice To Provide Private Health Insurance" (effective or revised effective date as identified in rule 5101:12-57-99 of the Administrative Code).

(D) Upon scheduling the medical support mistake of fact hearing the CSEA shall:

(1) Ensure the medical support mistake of fact hearing to be held on a date that is no later than ten days after the date the request was received; and

(2) Issue a JFS 07053, "Notice of Medical Support Mistake of Fact Hearing"(effective or revised effective date as identified in rule 5101:12-57-99 of the Administrative Code), to both parties no later than five days before the date that the medical support mistake of fact hearing is scheduled to be conducted.

(E) The CSEA shall issue a JFS 07058, "Medical Support Mistake of Fact Hearing Determination" (effective or revised effective date as identified in rule 5101:12-57-99 of the Administrative Code), to the requesting party when denying a medical support mistake of fact hearing within fourteen days of the date that the request was filed with the CSEA.

A CSEA may deny a request for a medical support mistake of fact hearing when:

(1) The request is not timely filed.

(2) The request is for a reason other than to contest whether:

(a) Private health insurance that is accessible and reasonable in cost is or is not being provided in accordance with the order, when at least one of the parties has been identified as the health insurance obligor; or

(b) Private health insurance that is accessible and reasonable in cost is or is not available to either party, when neither party has been identified as the health insurance obligor.

(3) The request is not submitted by the obligor, the obligor's representative, or the obligee or the obligee's representative.

(F) No later than the scheduled date of the medical support mistake of fact hearing, the parties may provide the CSEA with any evidence or relevant information necessary for the CSEA to properly review whether private health insurance coverage that is accessible and reasonable in cost is available to:

(1) The health insurance obligor(s); or

(2) Either party, when a health insurance obligor has not been identified.

(G) At the medical support mistake of fact hearing, the CSEA shall:

(1) Review the information that led to the issuance of the JFS 04031, JFS 04032, or JFS 04033;

(2) Consider any testimony or evidence submitted by either party or received independently from another source that is relevant to the issues to be addressed; and

(3) Determine whether private health insurance coverage that is accessible and reasonable in cost is available to:

(a) The health insurance obligor(s); or

(b) Either party, when a health insurance obligor has not been identified.

(H) No later than fourteen days from the date of the medical support mistake of fact hearing, the CSEA shall:

(1) Issue a JFS 07058 to both parties.

(2) Record the results of the medical support mistake of fact hearing in and make any necessary changes to the support enforcement tracking system based on the results of the hearing.

(I) Each party has the right to file for a court hearing to object to the determination made by the CSEA within seven business days of the date that the CSEA issues the JFS 07058.

Replaces: 5101:12-57-08

Effective: 1/1/2015
Five Year Review (FYR) Dates: 01/01/2020
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.30
Prior Effective Dates: 03/01/09

5101:12-57-10 National medical support notice.

(A) The OMB 0970-0222, "National Medical Support Notice" (expiration date 02/29/2008), (NMSN) requires the enrollment in health insurance of the child subject to the child support order and the deduction of premiums for the cost of the health insurance, when available.

(B) The NMSN contains instructions and two parts (hereinafter referred to as "part A" and "part B").

(1) Part A includes:

(a) The notice to withhold for health care coverage, which is completed by the child support enforcement agency (CSEA); and

(b) The employer's response, which is completed by the employer.

(2) Part B includes:

(a) The medical support notice to the plan administrator, which is forwarded to the health plan administrator; and

(b) The plan administrator's response, which is completed by the health plan administrator.

(C) In accordance with sections 3119.33 and 3119.34 of the Revised Code and except when excluded as described in paragraph (E) of this rule, the CSEA shall issue the NMSN to the employer of the health insurance obligor. The CSEA shall issue the NMSN not later than the business day after receipt of a new hire match from the national directory of new hires (NDNH) for the health insurance obligor. In addition, the CSEA shall issue the NMSN as a result of the discovery of new employment for the health insurance obligor by the CSEA through a source other than the NDNH.

(D) In accordance with section 3119.35 of the Revised Code, at the same time the CSEA issues the NMSN, the CSEA shall issue:

(1) The JFS 03377, "Employer/Health Plan Administrator Health Insurance Verification Request" (rev. 05/2005), to the employer; and

(2) The JFS 04036, "Notice of Medical Support Enforcement Activity" (rev. 01/2006), to the health insurance obligor. When the CSEA does not have a valid address for the health insurance obligor, the CSEA shall mail the JFS 04036 to the address of the employer.

(E) The CSEA shall not issue the NMSN when the CSEA has determined the health insurance obligor is an active member of the military.

(1) The CSEA shall verify the child's enrollment status through the defense enrollment eligibility reporting system and document the information and the source of the information in the case record.

(2) When the eligible child is not enrolled in the health plan, the CSEA shall notify the custodial parent of the need to take the child to a military rapid center for enrollment in the health plan.

Effective: 05/01/2012
R.C. 119.032 review dates: 12/22/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.33 , 3119.34 , 3119.35
Prior Effective Dates: 1/7/85, 8/1/86, 12/1/87, 12/20/88, 9/1/89, 8/1/90, 6/1/91, 11/1/91, 7/15/92, 4/1/93, 1/1/98, 10/2/03, 1/1/07

5101:12-57-10.1 Responsibility of employer.

(A) In accordance with section 3119.36 of the Revised Code, upon receipt of the OMB 0970-0222, "National Medical Support Notice" (expiration date 02/29/2008), (NMSN) and the JFS 03377, "Employer/Health Plan Administrator Health Insurance Verification Request" (rev. 05/2005), the employer is required, not later than twenty business days after the date of the NMSN, to do one of the following:

(1) When the person named in the NMSN is a current employee and the person and the child listed on the NMSN are already enrolled in health insurance coverage through the employer, complete and return the JFS 03377 to the CSEA.

(2) When the person named in the NMSN is a current employee and health insurance coverage of the child is available through the employer, send part B of the NMSN and the JFS 03377 to the health plan administrator.

(3) Complete and return part A of the NMSN to the CSEA when:

(a) The person named in the NMSN is not a current employee;

(b) The employee is among a class of employees that are not eligible for family health coverage under any group health plan maintained by the employer or to which the employer contributes;

(c) The employer does not maintain or contribute to plans providing dependent or family health care coverage; or

(d) The employer determines that coverage of the child would cause the total amount of income withholding, which includes child support and health insurance contributions, to exceed the withholding limitation permitted under the Consumer Credit Protection Act, Pub. L. No. 90-321, 82 Stat. 146 (1968), 15 U.S.C. 1673(b) .

(B) In accordance with sections 3119.362 and 3119.364 of the Revised Code, an employer who receives an NMSN is required to:

(1) Upon written request from the other parent, any person subject to the order, or the CSEA, release to the requestor all information about the employee's health insurance coverage, which may include the name and address of the health plan administrator and any policy, contract or plan number; and

(2) Notify the CSEA of any change in or the termination of the health insurance coverage that is maintained pursuant to the NMSN.

Replaces: Part of 5101:1-29- 35.2

R.C. 119.032 review dates: 12/22/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.36 , 3119.362 , 3119.364
Prior Effective Dates: 1/7/85, 8/1/86, 12/1/87, 12/20/88, 9/1/89, 8/1/90, 6/1/91, 11/1/91, 7/15/92, 4/1/93, 1/1/98, 10/2/03, 1/1/07

5101:12-57-10.2 Responsibility of health plan administrator.

(A) In accordance with section 3119.37 of the Revised Code, upon receipt of the OMB 0970-0222, "National Medical Support Notice" (expiration date 02/29/2008), (NMSN) and the JFS 03377, "Employer/Health Plan Administrator Health Insurance Verification Request" (rev. 05/2005), the health plan administrator is required to:

(1) Complete and return part B of the NMSN to the child support enforcement agency (CSEA) within forty business days of the date of the NMSN; and

(2) Comply with the enrollment requirements in accordance with the instructions contained in the NMSN.

(B) When there is more than one health coverage option available under the plan and the health insurance obligor is not enrolled in any of the options:

(1) The health plan administrator is required to attach to part B copies of applicable summary plan descriptions or other documents that describe available coverage, including the additional participant contribution necessary to obtain coverage for the child under each option and whether there is a limited service area for any option.

(2) When the health plan has a default option and the CSEA fails to notify the health plan administrator of the health coverage selection within twenty business days, the health plan administrator is required to enroll the child in the health plan's default option.

(C) After the child has been enrolled in a health plan option, the health plan administrator is required to complete and return the JFS 03377 to the CSEA.

(D) In accordance with section 3119.422 of the Revised Code, nothing in rules 5101:12-47-01, 5101:12-57-01, or 5101:12-57-10 to 5101:12-57- 10.6 of the Administrative Code shall be construed to require the health plan administrator to accept for enrollment any child who does not meet the underwriting standards of the health insurance or health care policy, contract, or plan for which application is made.

Effective: 05/01/2012
R.C. 119.032 review dates: 12/22/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.37 , 3119.422
Prior Effective Dates: 1/7/85, 8/1/86, 12/1/87, 12/20/88, 9/1/89, 8/1/90, 6/1/91, 11/1/91, 7/15/92, 4/1/93, 1/1/98, 10/2/03, 1/1/07

5101:12-57-10.3 Selecting a health plan option.

(A) When the child support enforcement agency (CSEA) receives from the health plan administrator part B of the OMB 0970-0222, "National Medical Support Notice" (expiration date 02/29/2008), (NMSN) and information on health plan options, the CSEA shall:

(1) Issue the JFS 04035, "Notice of Available Health Plan Options" (rev. 02/2006), to the custodial parent or caretaker of the child; and

(2) Attach to the JFS 04035 all information regarding health plan options received from the health plan administrator.

(B) Within five days from the issuance date on the JFS 04035, the custodial parent or caretaker of the child is required to return to the CSEA the portion of the JFS 04035 documenting the health plan option selected by the custodial parent or caretaker of the child.

(C) Within twenty business days from the date the health plan administrator sends part B of the NMSN to the CSEA, the CSEA shall issue the JFS 04034, "Notice of Selection of Health Plan Option" (rev. 12/2005), to the health plan administrator and issue a copy to the custodial parent or caretaker of the child.

(D) When the health plan does not have a default option and the CSEA fails to notify the health plan administrator of the health care selection within twenty business days, the CSEA retains responsibility for selecting a health plan option for the child.

Replaces: Part of 5101:1-29- 35.2

R.C. 119.032 review dates: 12/22/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3125.03
Prior Effective Dates: 1/7/85, 8/1/86, 12/1/87, 12/20/88, 9/1/89, 8/1/90, 6/1/91, 11/1/91, 7/15/92, 4/1/93, 1/1/98, 10/2/03, 1/1/07

5101:12-57-10.4 Administrative mistake of fact hearing regarding the national medical support notice.

(A) In accordance with section 3119.39 of the Revised Code, when a JFS 04036, "Notice of Medical Support Enforcement Activity" (rev. 01/2006), is issued and the health insurance obligor fails to make a timely request for an administrative hearing, the JFS 04036 becomes a final and enforceable determination of the child support enforcement agency (CSEA) that issued the JFS 04036.

(B) A health insurance obligor who receives an OMB 0970-0222, "National Medical Support Notice" (expiration date 02/29/2008) (NMSN), or a JFS 04036 may request an administrative mistake of fact hearing for any of the following reasons:

(1) Error in the identity of the parties to the support order listed on the NMSN;

(2) Error in the identity of one or more of the children listed on the NMSN;

(3) The child support order authorizes the provision of health insurance coverage through an alternative group policy, contract, or plan and alternative coverage is in effect; or

(4) The coverage identified in the NMSN is not consistent with the medical support provision in the child support order.

(C) In accordance with section 3119.38 of the Revised Code, the health insurance obligor must file a written request for an administrative mistake of fact hearing with the CSEA that issued the notice not later than seven business days after the date on which the JFS 04036 is issued.

(D) In accordance with section 3119.38 of the Revised Code, when the health insurance obligor makes a timely request for an administrative mistake of fact hearing, the CSEA shall:

(1) Conduct an administrative mistake of fact hearing not later than ten days after the date on which the health insurance obligor files the request for the administrative mistake of fact hearing; and

(2) Issue the JFS 03399, "Notice of Administrative Mistake of Fact Hearing" (rev. 02/2003), to the health insurance obligor and any other individual the CSEA determines appropriate not later than five days before the date on which the administrative mistake of fact hearing is to be conducted.

(E) In accordance with section 3119.41 of the Revised Code, when an administrative mistake of fact process is pending, the employer is required to continue the withholding of amounts for health insurance pursuant to the NMSN.

(F) In accordance with section 3119.38 of the Revised Code, at the administrative hearing, the CSEA shall determine whether there is a mistake of fact in the NMSN.

(G) After the hearing has been held, the CSEA shall issue the JFS 04037, "Medical Support Enforcement Administrative Mistake of Fact Hearing Decision" (rev. 02/2006), to the health insurance obligor. When the health insurance obligor is the non-custodial parent, the CSEA shall send a copy of the JFS 04037 to the custodial parent.

(H) In accordance with section 3119.41 of the Revised Code:

(1) When the CSEA determines that no mistake of fact exists, the NMSN shall remain in effect.

(2) When the CSEA determines that a mistake of fact does exist, the CSEA shall take whatever action is necessary regarding the NMSN, which may include issuing a corrected NMSN or terminating the NMSN.

(I) When an administrative mistake of fact hearing determines that the person named as the health insurance obligor was named in error and premiums have been deducted, the CSEA shall not address the decision for reimbursement.

(J) In accordance with section 3119.38 of the Revised Code, the administrative mistake of fact hearing determination is final unless, within seven business days after the CSEA issues the JFS 04037, the health insurance obligor files a written motion with the court of jurisdiction in the county in which the support order is administered for a hearing to determine whether there is still a mistake of fact in the NMSN.

Replaces: Part of 5101:1-29- 35.2

R.C. 119.032 review dates: 12/22/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.38 , 3119.39 , 3119.41
Prior Effective Dates: 1/7/85, 8/1/86, 12/1/87, 12/20/88, 9/1/89, 8/1/90, 6/1/91, 11/1/91, 7/15/92, 4/1/93, 1/1/98, 10/2/03, 1/1/07

5101:12-57-10.5 Court mistake of fact hearing regarding the national medical support notice.

(A) When the health insurance obligor files a timely, written motion for a court hearing, the court is required by section 3119.40 of the Revised Code to:

(1) Send to the health insurance obligor and to any other individual the child support enforcement agency (CSEA) determines appropriate written notice by regular mail of the date, time, place, and purpose of the hearing not later than five days before the date the court hearing is to be held;

(2) Hold the hearing as soon as possible, but not later than ten days after the motion is filed; and

(3) Limit the hearing to determining whether there is a mistake of fact in the OMB 0970-0222, "National Medical Support Notice" (expiration date 02/29/2008) (NMSN).

(B) In accordance with section 3119.41 of the Revised Code, when a court mistake of fact process is pending, the employer is required to continue the withholding of amounts for health insurance pursuant to the NMSN.

(C) In accordance with section 3119.40 of the Revised Code, the court is required to determine on conclusion of the hearing whether there is a mistake of fact in the NMSN. The court's determination is final.

(D) In accordance with section 3119.41 of the Revised Code:

(1) When the court determines that no mistake of fact exists in the NMSN, the NMSN shall remain in effect.

(2) When the court determines that a mistake of fact does exist in the NMSN, the court is required to take whatever action is necessary regarding the NMSN, which may include correcting or terminating the NMSN.

(E) When the court mistake of fact hearing determines that the person named as the health insurance obligor was named in error, premiums have been deducted, and the court does not address the decision for reimbursement, the decision for reimbursement is the responsibility of the employer and the insurance company health plan administrator.

Replaces: Part of 5101:1-29- 35.2

R.C. 119.032 review dates: 12/22/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3119.40 , 3119.41
Prior Effective Dates: 1/7/85, 8/1/86, 12/1/87, 12/20/88, 9/1/89, 8/1/90, 6/1/91, 11/1/91, 7/15/92, 4/1/93, 1/1/98, 10/2/03, 1/1/07

5101:12-57-10.6 Terminating the national medical support notice.

A child support enforcement agency (CSEA) shall issue the JFS 04098, "Notice Regarding NMSN Withholding Requirements" (rev. 8/2008), when:

(A) The health insurance obligor is no longer responsible for the medical support provision to provide health insurance coverage for the child or there is no longer a current order with medical support provisions in effect;

(B) The person identified on the OMB 0970-0222, "National Medical Support Notice" (expiration date 03/31/2011), as the health insurance obligor has provided verification to the CSEA that the person is not subject to the medical support provision to provide health insurance coverage for the child;

(C) As the result of a medical support mistake of fact hearing, the CSEA has determined that the private health insurance is not accessible or reasonable in cost; or

(D) Health insurance coverage is provided through a source other than the health insurance obligor's employer and:

(1) The underlying medical support provision to provide health insurance coverage for the child authorizes alternative health care coverage; and

(2) The health insurance obligor provides verification to the CSEA that the alternative coverage is currently in effect.

R.C. 119.032 review dates: 12/22/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3119.51
Rule Amplifies: 3125.03 , 3119.41
Prior Effective Dates: 1/7/85, 8/1/86, 12/1/87, 12/20/88, 9/1/89, 8/1/90, 6/1/91, 11/1/91, 7/15/92, 4/1/93, 1/1/98, 10/2/03, 1/1/07, 3/1/09

5101:12-57-20 Medical support payment. [Rescinded].

Rescinded eff 12-1-08

5101:12-57-99 [Effective 1/1/2015] Chapter 5101:12-57 forms - enforcement of medical support provisions.

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

(A) JFS 03377, "Employer/Health Plan Administrator Health Insurance Verification Request" (rev. 9/2015);

(B) JFS 03399, "Notice of Administrative Mistake of Fact Hearing" (rev. 9/2015);

(C) JFS 04031, "Notice Regarding Cash Medical Support Order" (rev. 9/2015);

(D) JFS 04032, "Notice to Provide Cash Medical Support" (rev. 9/2015);

(E) JFS 04033, "Notice to Provide Private Health Insurance" (rev. 9/2015);

(F) JFS 04034, "Notice of Selection of Health Plan Option" (rev. 9/2015);

(G) JFS 04035, "Notice of Available Health Plan Options" (rev. 9/2015);

(H) JFS 04036, "Notice of Medical Support Enforcement Activity" (rev. 9/2015);

(I) JFS 04037, "Medical Support Enforcement Administrative Mistake of Fact Hearing Decision" (rev. 9/2015);

(J) JFS 04098, "Notice Regarding NMSN Withholding Requirements" (rev. 9/2015);

(K) JFS 07053, "Notice of Medical Support Mistake of Fact Hearing" (rev. 9/2015); and

(L) JFS 07058, "Medical Support Mistake of Fact Hearing Determination" (rev. 9/2015).

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