Use this tool to compute the actual monthly premium for the children in the case. If pro rata share is less than or equal to 5% it is affordable. Enter the monthly health insurance premium line to the guidelines.
The actual monthly health premium cost paid by parent or other custodian for the adults and
child(ren) in the household.
Cost of insurance monthly for adult(s) only
The number of dependent children being covered. This includes
children on this
case and other
children covered on the health insurance.
Premium Cost Per Child
The Number of Children On This Order
Monthly Health Insurance Premium Costs for chid(ren) on this case
(use this amount in guidelines)
Monthly health insurance share per parent (pro rata share cost per parent)
5% of Gross Monthly Income
Father
$0.00
Mother
$0.00