Health Insurance Disclosure

HEALTH INSURANCE DISCLOSURE FORM. This form from the Tuscola County Friend of the Court is used to collect current information about health insurance coverage for minor children involved in a domestic relations or child support case. The form requires the submitting party to provide their contact information, employer details, and to indicate whether they or their spouse carry any type of health insurance—including private, employer-sponsored, or state aid—that covers the children. If insurance is in place, the form asks for the name and address of the insurance company, group and policy numbers, effective date, and the types of coverage provided (such as medical, dental, vision, prescription, or hospitalization). The names and birthdates of all covered children must also be listed. A photocopy of the insurance card (front and back) must be attached. www.FormsWorkflow.com