Health insurance costs
DIRECTIONS: Enter the monthly amount of any premium paid or to be paid or deducted or to be
deducted by an employer from gross monthly income for a health insurance policy for the children who
are the subject of this proceeding. 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.
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.
EXAMPLE: Parent A 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 Parent B. In a proceeding to modify
Parent A's child support obligation under the judgment of dissolution of his marriage to Parent B,
the monthly health insurance cost includable in Form No. 14 is calculated as follows:
Total monthly premium ($200) multiplied by number of children in this proceeding (3) divided by total
persons insured by premium (6) equals monthly health insurance credit to include on Form 14 ($100).