Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Notice Of Rights And Responsibilities Health Care Costs And Reimbursement Procedures Form. This is a California form and can be use in Family Law - Dissolution - Legal Separation -Annulment Judicial Council.
Loading PDF...
Tags: Notice Of Rights And Responsibilities Health Care Costs And Reimbursement Procedures, FL-192, California Judicial Council, Family Law - Dissolution - Legal Separation -Annulment
FL-192
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
IF YOU HAVE A CHILD SUPPORT ORDER THAT INCLUDES A PROVISION FOR THE
REIMBURSEMENT OF A PORTION OF THE CHILD’S OR CHILDREN’S HEALTH-CARE COSTS
AND THOSE COSTS ARE NOT PAID BY INSURANCE, THE LAW SAYS:
1. Notice. You must give the other parent an
itemized statement of the charges that have
been billed for any health-care costs not paid
by insurance. You must give this statement to
the other parent within a reasonable time, but
no more than 30 days after those costs were
given to you.
2. Proof of full payment. If you have already
paid all of the uninsured costs, you must
(1) give the other parent proof that you paid
them and (2) ask for reimbursement for the
other parent’s court-ordered share of those
costs.
3. Proof of partial payment. If you have paid
only your share of the uninsured costs, you
must (1) give the other parent proof that you
paid your share, (2) ask that the other parent
pay his or her share of the costs directly to the
health-care provider, and (3) give the other
parent the information necessary for that
parent to be able to pay the bill.
4. Payment by notified parent. If you receive
notice from a parent that an uninsured
health-care cost has been incurred, you must
pay your share of that cost within the time the
court orders; or if the court has not specified a
period of time, you must make payment
(1) within 30 days from the time you were given
notice of the amount due, (2) according to any
payment schedule set by the healthcare provider, (3) according to a schedule
agreed to in writing by you and the other
parent, or (4) according to a schedule adopted
by the court.
5. Disputed charges. If you dispute a charge,
you may file a motion in court to resolve the
dispute, but only if you pay that charge before
filing your motion.
If you claim that the other party has failed to
reimburse you for a payment, or the other party
has failed to make a payment to the provider
after proper notice has been given, you may file
a motion in court to resolve the dispute. The
court will presume that if uninsured costs have
been paid, those costs were reasonable. The
court may award attorney fees and costs
against a party who has been unreasonable.
6. Court-ordered insurance coverage. If a
parent provides health-care insurance as
ordered by the court, that insurance must be
used at all times to the extent that it is available
for health-care costs.
a. Burden to prove. The party claiming
that the coverage is inadequate to meet the
child's needs has the burden of proving that
to the court.
b. Cost of additional coverage. If a parent
purchases health-care insurance in addition
to that ordered by the court, that parent must
pay all the costs of the additional coverage.
In addition, if a parent uses alternative
coverage that costs more than the coverage
provided by court order, that parent must pay
the difference.
7. Preferred health providers. If the
court-ordered coverage designates a preferred
health-care provider, that provider must be
used at all times consistent with the terms of
the health insurance policy. When any party
uses a health-care provider other than the
preferred provider, any health-care costs that
would have been paid by the preferred health
provider if that provider had been used must be
the sole responsibility of the party incurring
those costs.
Page 1 of 2
Form Approved for Optional Use
Judicial Council of California
FL-192 [Rev. July 1, 2007]
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
Family Code, §§ 4062, 4063
www.courtinfo.ca.gov
American LegalNet, Inc.
www.FormsWorkflow.com
INFORMATION SHEET ON CHANGING A CHILD SUPPORT ORDER
FL-192
General Information
The court has just made a child support order in your case. This order will remain the same unless a party to the action requests that the
support be changed (modified). An order for child support can be modified only by filing a motion to change child support and serving
each party involved in your case. If both parents and the local child support agency (if it is involved) agree on a new child support
amount, you can complete, have all parties sign, and file with the court a Stipulation to Establish or Modify Child Support and Order
(form FL-350) or Stipulation and Order (Governmental) (form FL-625).
When a Child Support Order May Be Modified
The court takes several things into account when ordering the payment of child support. First, the number of children is considered.
Next, the net incomes of both parents are determined, along with the percentage of time each parent has physical custody of the
children. The court considers both parties’ tax filing status and may consider hardships, such as a child of another relationship. An
existing order for child support may be modified when the net income of one of the parents changes significantly, the parenting schedule
changes significantly, or a new child is born.
Examples
• You have been ordered to pay $500 per month in child support. You lose your job. You will continue to owe $500 per month, plus
10 percent interest on any unpaid support, unless you file a motion to modify your child support to a lower amount and the court
orders a reduction.
• You are currently receiving $300 per month in child support from the other parent, whose net income has just increased
substantially. You will continue to receive $300 per month unless you file a motion to modify your child support to a higher amount
and the court orders an increase.
• You are paying child support based upon having physical custody of your children 30 percent of the time. After several months it
turns out that you actually have physical custody of the children 50 percent of the time. You may file a motion to modify child support
to a lower amount.
How to Change a Child Support Order
To change a child support order, you must file papers with the court. Remember: You must follow the order you have now.
What forms do I need?
If you are asking to change a child support order open with the local child support agency, you must fill out one of these forms:
• FL-680, Notice of Motion (Governmental) or FL-683 Order to Show Cause (Governmental) and
• FL-684, Request for Order and Supporting Declaration (Governmental)
If you are asking to change a child support order that is not open with the local child support agency, you must fill out one of these
forms:
• FL-301, Notice of Motion or FL-300, Order to Show Cause and
• FL-310, Application for Order and Supporting Declaration or
• FL-390, Notice of Motion and Motion for Simplified Modification of Order for Child, Spousal, or Family Support
You must also fill out one of these forms:
• FL-150, Income and Expense Declaration or FL-155, Financial Statement (Simplified)
What if I am not sure which forms to fill out?
Talk to the family law facilitator at your court.
After you fill out the forms, file them with the court clerk and ask for a hearing date. Write the hearing date on the form.
The clerk will ask you to pay a filing fee. If you cannot afford the fee, fill out these forms, too:
• Form FW-001, Application for Waiver of Court Fees and Costs
• Form FW-003, Order on Application for Waiver of Court Fees and Costs
You must serve the other parent. If the local child support agency is involved, serve it too.
This means someone 18 or over—not you—must serve the other parent copies of your filed court forms at least 16 court days before
the hearing. Add 5 calendar days if you serve by mail within California (see Code of Civil Procedure section 1005 for other situations).
Court days are weekdays when the court is open for business (Monday through Friday except court holidays). Calendar days include
all days of the month, including weekends and holidays. To determine court and calendar days, go to
www.courtinfo.ca.gov/selfhelp/courtcalendars/.
The server must also serve blank copies of these forms:
• FL-320, Responsive Declaration to Order to Show Cause or Notice of Motion and FL-150, Income and Expense Declaration, or
• FL-155, Financial Statement (Simplified)
Then the server fills out and signs a Proof of Service (form FL-330 or FL-335). Take this form to the clerk and file it.
Go to your hearing and ask the judge to change the support. Bring your tax returns from the last two years and your last two
months’ pay stubs. The judge will look at your information, listen to both parents, and make an order. After the hearing, fill out:
• FL-340, Findings and Order After Hearing and
• FL-342, Child Support Information and Order Attachment
Need help?
Contact the family law facilitator in your county or call your county's bar association and ask for an experienced family lawyer.
FL-192 [Rev. July 1, 2007]
NOTICE OF RIGHTS AND RESPONSIBILITES
Health-Care Costs and Reimbursement Procedures
Page 2 of 2