Health Insurance Affidavit
Ohio · Supreme Court of Ohio
This form is an affidavit used to provide information about the health insurance coverage available for children in a case. It asks questions about whether the children are covered by government programs, individual plans, marketplace plans, or group plans, and asks for details about the available insurance.
Where this fits in a case
MotionsStage: Motions
This form is used to disclose health insurance coverage for children in a relationship case and is also used when determining child support. Users are instructed to check local court rules to know when it must be filed.
Either party may file.
Common questions
- Who fills out this form?
- The form is an affidavit, meaning the person filling it out must swear or affirm that the information is true and accurate. It is used by either party in the case.
- What information does this form collect?
- It collects details about the children's health insurance, asking about government programs, individual plans, marketplace plans, and group plans. It also asks for premium amounts and the name of the insurance group.
- Does this form need a notary?
- The section for the oath or affirmation must be signed in the presence of a Notary Public.
Revision history
No changes recorded since we started tracking this form on October 10, 2026.
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