Establishing a Medical Support Order: Requirements, Standards, and Exceptions

Legal Authority:

• OAC 340:25-5-168

When CSS establishes a child support order, medical support is also established in accordance with OAC 340:25-5-168. This applies not only to cases initiated by CSS but also those in which OKDHS is a necessary party to an action filed by a private individual.

Establishing a Medical Support Order

To establish the medical support order, the following standards must be met to fulfill the basic legal requirements in Oklahoma related to medical support orders:

Standards for Medical Support Provision

When choosing a medical support provision, request the court to apply the following:

1. Health care coverage must be reasonable in cost, meaning the pro rata share of the actual out-of-pocket premium cost for the child(ren) does not exceed five percent (5%) of the gross income of the responsible parent.
2. Health care coverage must be accessible, meaning the health care providers must be available to meet the child(ren)’s individual health care needs, and must be located no more than 60 miles one-way from the primary residence of the child(ren).
3. Health care coverage must provide for both routine and major medical expenses, including but not limited to the following: preventive care, office visits, hospitalization, and medication coverage. Annual deductibles must be reasonable and relate to the medical circumstances of the child(ren). Limited Benefit Health Insurance Coverage does not satisfy this requirement. The court may designate the maximum annual deductible. CSS recommends the deductible be no more than $500.00 per year.
4. If cash medical (CM) support is ordered the order must provide for the possible future termination of CM support except for certain circumstances.
5. An order that requires the parents to share any health care expenses for the child(ren) that are not covered by health care coverage.

Examples of orders that would not meet the requirements:

• An order that requires the parents to share uninsured health care expenses proportionately but does not order either to provide health care coverage or pay CM support.
• Health care coverage with an excessive deductible amount (i.e., $10,000.00 per year).
• The child support computation sheet makes it clear that one of the parents is paying a health care coverage premium, but the text of the order does not require the parent to do so.
• An order for CM support that does not allow for its termination.
• Health care coverage which only provides for accidents.
• The order does not have any findings about what health care coverage is in effect or offered.

Exceptions to Standards for Medical Support Provision

When the parents agree or it is otherwise appropriate, you can request that the court make an exception to the standards for health care coverage when:

• The pro rata share of the actual premium cost for the child(ren) paid by the insured exceeds five percent (5%) of the gross income of the parent ordered to provide health care coverage; or
• The closest health care provider exceeds 60 miles one-way from the primary residence of the child(ren).

For more information on completing the medical section of an order, check out the CS Quest article How to Complete the Medical Section of an Order – Child Support Quest (oucpm.org).