Texas Exhibit Medical Child Support Order Form

The Exhibit Medical Child Support Order is a form that is used to order one of the spouses to pay for the health insurance of the other child after the divorce has been completed. This can be decided for a stated period or for an indefinite amount.

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Exhibit: Medical Support Order	 	
Warning!  If you disobey a Court order to pay for or provide health insurance for the children, you will have to 
pay for ALL needed and reasonable health costs, even if those costs would not have been covered by an 
insurance policy.   	
The Court makes the following orders: 
1.  I	
NSURING 	PARENT	 	
 
IT IS ORDERED that _______________________________________________________________	
 	
(Name of person to pay health insurance/ medical support,  Insuring Parent) 	
 
must  pay for and provide health insurance / medical benefits for the children listed in the 
attached Decree or Order, in the manner described below, until one of the following  
conditions  is met for each child, or one of the following  events occurs: 	
 	
Conditions 	
  The child turns 18 and graduates from high school,  or 
   The child has turned 18, and is not  meeting the attendance requirements of a high 
school or other secondary school leading toward a high school diploma,  or  
   The child marries, dies, or is emancipated by court order,  or  
   The child begins active duty in the US armed forces,  or 	
 	
Events 	
  The child’s parents marry each other and live with the child,  or  
   The court changes this order. 	
 	
The medical benefits must include doctor services, office visits, hospitalization, laboratory, X-ray, 
and emergency services. 	
 	
 	
2.  I	NSURANCE 	/ M	EDICAL 	BENEFITS	 	
  The Insuring Parent IS ORDERED to pay for and enroll the children in a health insurance policy 
offered through either parent’s work or membership in a union or organization, if it is available at 
a reasonable cost (not more than 9% of his/her annual resources), and it provides doctor 
services, office visits, hospitalization, laboratory, X-ray, and emergency services	
. 	
 
If the Insuring Parent obtains health insurance through the other parent’s work or membership in 
an organization, that other parent IS ORDERED to include the child in his or her health 
insurance.  The Insuring Parent IS ORDERED to reimburse the other parent for the  actual cost 
of insuring the children in this case, as described below.  
 
If insurance is  not available through either parent’s work or membership in a union or 
organization at a reasonable cost, the Insuring Parent IS ORDERED to get insurance / medical 	
© Texas  Partnership for Legal Access Exhibit:  Medical Support, Aug. 2009  Page 1 of 4  
Texas Family Code, Chapter 154, Subchapter D Medical Support for Child;  Section 154.064

© Texas Partnership for Legal Access Exhibit:  Medical Support, Aug. 2009  Page 2 of 4  
Texas Family Code, Chapter 154, Subchapter D Medical Support for Child;  Section 154.064  
 	
benefits for the children using any of these options: 	 	
1.   Buy an individual policy to cover the children, and give the other parent the required health 
 insurance information listed below,  or  
 
2.   Get public health insurance. 	
(For information, contact TexC are Partnership: 1-800-647-6558, 	
www.texcarepartnership.com	.), or  	
 	
3.   Give the other parent $_____________/ per month in medical support for the children’s health 
 expenses. Payments must be 	
(check one):  	
  Mailed to the Child Support State Disbursement Unit on the1st day each m\
onth,  or 
  Withheld by the Insuring Parent’s Employer and included in Child Support. 	
  
The Insuring Parent is not required to make these payments if he or she obtains health insurance 
for the child and provides proof of insurance to the other parent, and any other party to the case. 	
  
 
3. 	
 INFORMATION TO BE PROVIDED	 	
  The Insuring Parent must give the other parent the following information, within 30 days of the date 
of this Order: 
   Name of the health insurance company, policy number, copy of the policy, and a lis\
t of 
covered benefits,  
   Proof that the children are covered under this policy,  
   A health insurance membership card, claim forms, and any other information needed to submit 
a claim, if applicable,  
   The Insuring Parent’s Social Security Number and name and address of the Insuring Parent’s 
employer and the type of insurance available through his/her employment. 
 
4.	
  NOTICE OF 	CHANGES TO 	INSURANCE 	/ M	EDICAL 	BENEFITS	 
1.  	
  If the insurance benefits are renewed, cancelled, or changed in any way, the Insuring Parent 
must send the new information to the other parent  within 15 days of the change. 
2.  If the Insuring Parent is no longer eligible for coverage, s/he must provide other health 
insurance within 10 days of losing coverage. The new insurance must provide as much, or 
more, coverage for the children. 
 	
 
5.	
  REIMBURSEMENT FOR 	ACTUAL 	COST TO 	INSURE 	CHILDREN IN THIS CASE 	 	
If the Insuring Parent obtains health insurance for the children through the other parent’s 
employment, the Insuring Parent must reimburse the other parent the  actual cost of insuring the 
children in this case.   
 
The actual cost  of insuring the children in this case is determined by dividing the total cost of 
insuring all children covered by the plan, and multip lying that number by the number of children in 
this case.

© Texas Partnership for Legal Access  Exhibit: Health Support, Aug. 2009  Page 3 of 4  
Texas Family Code, Chapter 154, Subchapter D Medical Support for Child; Section 154.064  
 	
The Insuring Parent is ORDERED to pay the actual cost of the health insurance for the children as 
additional child support, with the first payment of $__________ due on the first day of the first 
month after this Decree is signed, and a like payment due on the first day of each month thereafter, 
until there is a change in the actual cost of the health insurance for the children in this case.  
Starting on the first day of the month after each change in the actual cost of health insurance for the 
children in this case, the Insuring Parent is ordered to pay the other parent the actual cost of 
insuring the children, and must continue to make like monthly payments on the first day of each 
month thereafter until there is another change in the actual cost of health insurance for the children 
in this case.   
 
IT IS ORDERED that these additional payments  for reimbursement of health insurance expenses 
shall be made through the  Child Support State Disbursement Unit, PO Box 659791, San 
Antonio, Texas, 78265,  and thereafter promptly remitted to the other parent for support of the 
children. 
 
IT IS FURTHER ORDERED that payments made by  the Insuring Parent for the reimbursement of 
health insurance premiums to the other parent shall stop if the Insuring Parent enrolls the children 
in a health insurance or medical benefits program, as described above, and the Insuring Parent 
provides the other parent or the IV-D agency, if needed, the information\
 listed in paragraph III, 
above.	
 
 	
If the insurance company sends reimbursement for services, it must be given to the parent who 
made the expense, within 3 days. If payment is not in that parent’s name, the other parent will 
endorse the check and forward the payment.  	
 
6.	
  FILING 	CLAIMS	 	
 Either parent may file a claim.  If claim forms or other information are needed for reimbursement, 
the parents must provide that information within 10 days of the request.	
  
 
7.	
  ADDITIONAL 	INSURANCE	 	
  
  Either parent may get additional health insurance for the children, at his/her own cost. If the 
additional insurance expands coverage for the children, the parents are ordered to make the 
benefits available.  
 	
 
8.	
  COSTS NOT COVERED BY 	INSURANCE	 
 	
1.  If the insurance does not cover all of the health care costs, the parents must each pay 
half (50%) of the health care costs not covered by the insurance, including:  	
    
   Annual deductibles   
  Co-pays  
   Charges for dental, vision, and orthodontic care   
   Charges for prescription drugs   
(Travel costs and the cost of over-the-counter drugs are NOT included.)

© Texas Partnership for Legal Access  Exhibit: Health Support, Aug. 2009  Page 4 of 4  
Texas Family Code, Chapter 154, Subchapter D Medical Support for Child; Section 154.064  
 	
2.  Notify the other parent about health care costs: 
 Each parent must notify the other parent of the health care costs incurred within 10 
days. After being notified, the other parent has 10 days to pay his/her portion of the 
health care cost. The court considers all health care costs to be reasonable, even if 
denied by the health insurance company.  
 
 	
9.	  FOR 	PATERNITY 	CASES AND 	SUITS 	AFFECTING THE 	PARENT	-C	HILD 	RELATIONSHIPS	 
 
	
  Check here if the Father will pay for 50% of the mother's pregnancy-related health care  expenses. (You can only ask for this if this is the  first Health Insurance Order for the child/ren in 
this case.)	
  
 	
The father IS ORDERED to pay 50% of the mother’s pregnancy-related health care expenses 
for the child/ren listed below: 
 
Child’s name    Date of Birth     
         	 
1.    	
  	    
2.  	
  	    
3.  	
  	    
4.  	
  	    
5.  	
  	    
6.