A. The court shall enter a medical support order in any case in which an ongoing child support order is entered or modified. Medical support, for the purpose of this section, is defined as health insurance, cash medical support, or a combination of both.

1. “Health insurance” includes:

a.fee for service,

b.health maintenance organization,

c.preferred provider organization, and

d.other types of coverage, including, but not limited to, Indian Health Services or Defense Eligibility Enrollment Reporting System (DEERS), which is available to either parent under which medical services could be provided to the dependent children.

2. “Cash medical support” means:

a.an amount ordered to be paid toward the cost of health coverage provided by a public entity or by a person other than the parents through employment or otherwise, or

b.fixed periodic payments for ongoing medical costs.

B. In entering a temporary order, the court shall order that any health insurance coverage in effect for the child continue in effect pending the entering of a final order, unless the court finds that the existing health insurance coverage is not reasonable in cost or is not accessible as defined in subsection D of this section. If there is no health insurance coverage in effect for the child or if the insurance in effect is not available at a reasonable cost or is not accessible, the court shall order health care coverage for the child as provided in this subsection, unless the court makes a written finding that good cause exists not to enter a temporary medical support order.

C. On entering a final order, the court shall:

1. Make specific orders with respect to the manner in which health care coverage is to be provided for the child, in accordance with the priorities identified in subsection F of this section; and

2. Require the parent ordered to provide health care coverage for the child as provided under this section to produce evidence to the court’s satisfaction that the parent has applied for or secured health insurance or has otherwise taken necessary action to provide for health care coverage for the child, as ordered by the court.

D. When the court enters a medical support order, the medical support order must be reasonable in cost and accessible.

1. “Reasonable in cost” means that the actual premium cost paid by the insured does not exceed five percent (5%) of the gross income of the responsible parent. To calculate the actual premium cost of the health insurance, the court shall:

a.deduct from the total insurance premium the cost of coverage for the parent and any other adults in the household,

b.divide the remainder by the number of dependent children being covered, and

c.multiply the amount per child by the number of children in the child support case under consideration.

2. “Accessible health insurance” means that:

a.there are available providers appropriate to meet the primary individual health care needs of the children no more than sixty (60) miles one way from the primary residence of the children.

b.If a parent has available health coverage which includes an option that would be accessible to the child, but the parent has not currently enrolled in that option, the court may require the parent to change existing coverage to an option that is accessible to the child.

3. If the parties agree or the court finds good cause exists, the court may order medical coverage in excess of the five percent (5%) cost standard or the sixty-mile distance standard.

E. The court shall consider the cost and quality of health insurance coverage available to the parties and shall give priority to health insurance coverage available through the employment of one of the parties if the coverage meets the standards in subsection D of this section. If both parents have coverage available, the court shall give priority to the preference of the custodial person.

F. In determining the manner in which health care coverage for the child is to be ordered, the court shall enter an order in accordance with the following priorities and subsection D of this section, unless a party shows good cause why a particular order would not be in the best interest of the child:

1. If health insurance is available for the child through the employment of a parent or membership in a union, trade association, or other organization, the court shall order that parent to enroll the child in the health insurance of the parent;

2. If health insurance is not available for the child under paragraph 1 of this subsection but is available to a parent from another source, the court may order that parent to provide health insurance for the child;

3. If the court finds that neither parent has access to private health insurance at a reasonable cost, the court shall order the parent awarded the exclusive right to designate the child’s primary residence or, to the extent permitted by law, the other parent to apply immediately on behalf of the child for participation in a government medical assistance program or health plan. If the child participates in a government medical assistance program or health plan, the court shall order cash medical support under paragraph 4 of this subsection, in accordance with rules promulgated by the Oklahoma Health Care Authority and the Oklahoma Department of Human Services;

4. Cash medical support.

a.If health insurance coverage is not available for the child under paragraph 1 or 2 of this subsection, the court shall determine the amount to be treated as the actual monthly medical costs for the child and order the obligor to pay, in addition to the obligors current child support obligation, an amount as cash medical support for the child.

b.The cash medical support order shall not exceed the pro rata share of the actual monthly medical expenses paid for the child, or five percent (5%) of the gross monthly income of the obligor, whichever is less.

c.(1)In determining the actual monthly medical costs for the child, the court shall determine:

(a)for children who are participating in a government medical assistance program or health plan, an amount consistent with rules promulgated by the Oklahoma Health Care Authority determining the rates established for the cost of providing medical care through a government medical assistance program or health plan, or

(b)for children who are not participating in a government medical assistance program or health plan, an amount consistent with rules promulgated by the Department of Human Services determining the average monthly cost of health care for uninsured children.

(2)The court may also consider:

(a)proof of past medical expenses incurred by either parent for the child,

(b)the current state of the health of the child, and

(c)any medical conditions of the child that would result in an increased monthly medical cost.

G. An order requiring the payment of cash medical support under paragraph 4 of subsection F of this section must allow the obligor to discontinue payment of the cash medical support if:

1. Health insurance for the child becomes available to the obligor at a reasonable cost; and

2. The obligor:

a.enrolls the child in the insurance plan, and

b.provides the obligee and, in a Title IV-D case, the Title IV-D agency, the information required under paragraph 2 of subsection C of this section.

H. 1. The actual health insurance premium for the child shall be allocated between the parents in the same proportion as their adjusted gross income and shall be added to the base child support obligation.

2. If the obligor pays the health insurance premium, the obligor shall receive credit against the base child support obligation for the allocated share of the health insurance premium for which the obligee is responsible.

3. If the obligee pays the health insurance premium, the obligor shall pay the allocated share of the health insurance premium to the obligee in addition to the base child support obligation.

4. The parent providing the health insurance coverage shall furnish to the other parent and to the Child Support Enforcement Division of the Department of Human Services, if services are being provided pursuant to Title IV, Part D of the Social Security Act, 42 U.S.C. Section 601 et seq., with timely written documentation of any change in the amount of the health insurance cost premium, carrier, or benefits within thirty (30) days of the date of the change. Upon receiving timely notification of the change of cost, the other parent is responsible for his or her percentage share of the changed cost of the health insurance.

5. If the court finds that the obligor has underpaid child support due to changes in the cost of health insurance, the amount of underpayment may established by the court and enforced in the same manner as any other delinquent child support judgment. If the court finds that the obligor has overpaid due to changes in health insurance coverage cost, the overpayment shall be satisfied:

a.by offset against any past-due child support owed to the obligee, or

b.by adjustment to the future child support amount over a thirty-six-month period.

I. Reasonable and necessary medical, dental, orthodontic, optometric, psychological, or any other physical or mental health expenses of the child incurred by either parent and not paid or reimbursed by insurance or included in a cash medical support order pursuant to paragraph 4 of subsection F of this section shall be allocated in the same proportion as the adjusted gross income of the parents as separate items that are not added to the base child support obligation. If reimbursement is required, the parent who incurs the expense shall provide the other parent with proof of the expense within forty-five (45) days of receiving the Explanation of Benefits from the insurance provider or other proof of the expense if the expense is not covered by insurance. The parent responsible for reimbursement shall pay his or her portion of the expense within forty-five (45) days of receipt of documentation of the expense.

J. In addition to any other sanctions ordered by the court, a parent incurring uninsured dependent health expenses or increased insurance premiums may be denied the right to receive credit or reimbursement for the expense or increased premium if that parent fails to comply with subsections H and I of this section.

K. The parent desiring an adjustment to the ongoing child support order due to a change in the amount of dependent health insurance premium shall initiate a review of the order in accordance with Section 10 of this act.