Missouri > Local Circuit Courts > 21st Circuit (St. Louis County) > Family
Parenting Plan Part B - Support CAFC502B - Missouri
| Parenting Plan Part B - Support Form. This is a Missouri form and can be used in Family 21st Circuit (St. Louis County) Local Circuit Courts . |
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Form CAFC502B Parenting Plan Part B Support Mother: Case Number County Exhibit Number Case Information Father: 1. Children's Information Part B of this parenting plan applies to ____________ child(ren). They are: 1. _______________________________ 4. _______________________________ 2. _______________________________ 3. _______________________________ 5. _______________________________ 6. _______________________________ 2. Medical Insurance Neither party is required to maintain medical insurance for the benefit of the children. A medical benefit plan is not available at reasonable cost through either parent's employer or union. No support rights have been assigned to the state of Missouri and the Family Support Division is not providing support enforcement services to either party. Father shall maintain and pay the cost of medical insurance for the benefit of the children. The cost of medical insurance to be paid by Father is _____________ per month. Mother shall maintain and pay the cost of medical insurance for the benefit of the children. The cost of medical insurance to be paid by Mother is _____________ per month. Neither party is required to maintain dental insurance for the benefit of the children. A dental benefit plan is not available at reasonable cost through either parent's employer or union. No support rights have been assigned to the state of Missouri and the Family Support Division is not providing support enforcement services to either party. Father shall maintain and pay the cost of dental insurance for the benefit of the children. The cost of dental insurance to be paid by Father is _____________ per month. Mother shall maintain and pay the cost of dental insurance for the benefit of the children. The cost of dental insurance to be paid by Mother is _____________ per month. In the event either parent is required to maintain medical or dental insurance, the parent providing the health benefit plan shall provide to the other parent an insurance identification card. If support rights have been assigned to the state of Missouri or the Family Support Division is providing support enforcement services to either party, the person paying support shall notify the Family Support Division regarding the availability of medical insurance coverage through an employer or a group plan, provide the name of the insurance provider when coverage is available, and inform the division of any change in access to such insurance coverage. As used herein, medical and dental expenses include amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body. This includes orthodontic and vision care, eyeglasses, contact lenses, and prescription drugs. It does not include cosmetic surgery that is directed at improving the patient's appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease. It does include expenses to improve a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease. Expenses for counseling for the minor children shall be included as medical and dental expenses if the counseling is provided by a licensed social worker, licensed professional counselor, licensed psychologist or licensed psychiatrist. 3. Dental Insurance 4. Cost of Medical and Dental Insurance 5. Medical and Dental Expenses Parenting Plan Part B Support of Children Page 1 Form CAFC502B-8/29/2009 American LegalNet, Inc. www.FormsWorkFlow.com 6. Payment of Medical and Dental Expenses not Covered by Insurance The person receiving support will pay all reasonable and necessary medical and dental expenses of the children not covered by insurance and the person paying support will reimburse the person receiving support for _______ percent of all such expenses that are actually paid by the person receiving support and are in excess of $250 per year per child. This does not include the uninsured extraordinary costs set forth in paragraph 7 below. No reimbursement of uncovered medical and dental expenses of the children will be allowed unless the person receiving support submits proof of such expenses to the person paying support in writing within 120 days of the date said expenses were incurred. The person paying support does not have the financial resources to contribute to the payment of medical or dental expenses of the children not covered by insurance. The person receiving support will be responsible for all reasonable and necessary medical or dental expenses of the children not covered by insurance. This does not apply to the medical costs listed in Paragraph 7 below. All reasonable and necessary medical or dental expenses of the children are covered by insurance. The person receiving support has not substantially complied with the terms of the health benefit coverage. The person receiving support will be responsible for all reasonable and necessary medical or dental expenses of the children not covered by insurance. This does not apply to the medical costs listed in Paragraph 7 below. Extraordinary medical costs are predictable and recurring, such as expenses for dental treatment, orthodontic treatment, asthma treatment and physical therapy. These expenses MAY be included in the Form 14 calculation. Uncovered Extraordinary Medical Costs to be Paid by Father INCLUDED on Form 14 _______________________________________________________ _______________________________________________________ Uncovered Extraordinary Medical Costs to be Paid by Mother INCLUDED on Form 14 _______________________________________________________ _______________________________________________________ Total Amount of Expense $___________ per month 7. Payment of Extraordinary Medical Costs to be included on Form 14 Total Amount of Expense $___________ per month 8. Payment of Work-Related Child Care Costs There are no reasonable work-related child care expenses incurred by the parties. The reasonable work-related child care costs of the children to be paid by Father are $___________ per month. The reasonable work-related child care costs of the children to be paid by Mother are $___________ per month. These amounts have been included in the child support calculation pursuant to Form 14. Mother will pay all reasonable work-related child care expenses. The cost of reasonable workrelated chil
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