Form 14 Child Support Amount Calculation Worksheet Page 23
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41calculated 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.
A. COMMENT: Health insurance costs for the children who are the subject of this
proceeding are included in Form No.14 for coverage that is employer provided or
privately obtained. Inclusion of such costs is not intended to mandate that either parent
acquire health insurance for the children, but either parent may be required by court or
administrative order to obtain health insurance for the children in conformity with state
statute.
B. EXAMPLE: Father has a health insurance policy available through his
employer at no cost for himself alone and at a cost of $200.00 per month for his family,
which includes his current spouse and five children, three of whom are children of his
marriage to Mother. In a proceeding to modify Father's child support obligation under the
judgment of dissolution of his marriage to Mother, the monthly health insurance cost
includable in Form No. 14 is calculated as follows:
Total monthly premium
X
Number of children
=
Health insurance
Persons for whom
who are the subject
cost includable in
premium is paid
of the proceeding
Form No. 14
$200.00
X
3
=
$100.00 per month
6
Line 6d: Uninsured extraordinary medical costs
DIRECTION: Enter the monthly amount of any uninsured extraordinary medical costs
23
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