Separation Agreement - Massachusetts Family Court (Page 6 of 8) in pdf

Separation Agreement - Massachusetts Family Court Page 6

Party B's health insurance coverage will be provided:

by Party B

by Party A for so long as it is available to him/her, and ifthere is any additional cost to

continued coverage for the insurance:

The additional out of pocket cost shall be paid by Party A I Party B. Payment

of the additional cost shall be made on or before

- - - - - - - . . . . : .

Party B shall have the option of choosing to provide his/her own health

insurance coverage and shall notify Party A in writing if he/she elects to do so. _

UNINSURED MEDICAL EXPENSES FOR EACH PARTY

The cost of all reasonable uninsured and unreimbursed medical, dental, hospital, optical,

prescription medication and therapeutic counseling services shall be paid:

By each party for himself/herself.

% of said expenses or $

Party A shall pay to Party B

for Party B.

Party B shall pay to Party A

% of said expenses or $

for Party A.

Copies of all invoices or bills shall be provided to the paying party within

days receipt.

All payments to be made directly to the other party within

days of receipt of the bill(s).

LIFE INSURANCE

Party A shall maintain life insurance in the face amount of $

- - - - - - - - -

naming as the beneficiary, and shall be required to keep the life insurance in effect

until

- - - - - - - - - -

Party B shall maintain life insurance in the face amount of $

nammg

as the beneficiary, and

shall be required to keep the life insurance in effect until

- - - - - - - - - -

Neither party shall be required to maintain life insurance for the benefit of the other.

OTHER PROVISIONS

Page 6 of 8

Separation Agreement - Massachusetts Family Court Page 6