Motion To Modify Child Support Forms Package (Page 11 of 36) in pdf

Medical and Dental Insurance for the Children

Cost of Medical or Dental Insurance for the Children

The cost of medical or dental insurance for the children is the monthly amount of any premium paid. If the

parent’s employer deducts the amount of premium from his or her pay, then the cost of medical or dental

insurance includes the amount of the premium paid. It does not include the cost of medical or dental insurance

for the parent, the parent’s spouse, or other children that are not covered by this parenting plan. The cost of

medical or dental insurance for the children is included on Line 6c of Form 14.

Form 14 states: “If the amount of the actual health insurance costs for the children who are the subject of

this proceeding is not available or cannot be verified, the amount of the health insurance costs attributable to the

children who are the subject of this proceeding shall be calculated by dividing the total monthly costs for the

policy of health insurance by the total number of persons for whom the costs are paid or to be paid and then

multiplying the resulting figure by the number of children insured under the policy who are the subject of this

proceeding.”

5. Parent Responsible for Medical Insurance

You must check one and only one of the following three boxes.

Form 14

Neither party is required to maintain medical insurance for the benefit of the children. A health benefit

plan is not available at reasonable cost through either parent’s employer or union. No support rights have been

assigned to the state of Missouri and the Family Support Division is not providing support enforcement services

to either party.

Father shall maintain and pay the cost of medical insurance for the benefit of the children.

Mother shall maintain and pay the cost of medical insurance for the benefit of the children.

6. Parent Responsible for Dental Insurance

You must check one and only one of the following three boxes.

Neither party is required to maintain dental insurance for the benefit of the children. A health benefit plan

is not available at reasonable cost through either parent’s employer or union. No support rights have been

assigned to the state of Missouri and the Family Support Division is not providing support enforcement services

to either party.

Father shall maintain and pay the cost of dental insurance for the benefit of the children.

Mother shall maintain and pay the cost of dental insurance for the benefit of the children.

7. Medical and Dental Insurance for the Children

The total cost of medical and dental insurance paid by Father for the children is ___________ per month.

The total cost of medical and dental insurance paid by Mother for the children is ___________ per month.

You must enter an amount on both lines, even if you enter “0”. These amounts should also be entered on line

6c of Form 14.

In the event either parent is required to maintain medical or dental insurance, the parent providing the

health benefit plan shall provide to the other parent an insurance identification card.

If support rights have been assigned to the state of Missouri or the Family Support Division is providing

support enforcement services to either party, the person paying support shall notify the Family Support Division

regarding the availability of medical insurance coverage through an employer or a group plan, provide the name

of the insurance provider when coverage is available, and inform the division of any change in access to such

insurance coverage.

Parenting Plan Part B - Support – Page 3

Form CAFC501-08/29/2009

This form is available for free at

Motion To Modify Child Support Forms Package Page 11

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