8b. QUALIFIED MEDICAL CHILD SUPPORT ORDER (Q.M.C.S.O.) (Form UD-8b):
A certified copy of this signed order must be served on the employer of the person legally responsible to provide health insurance.
Fields 1-4: The court will fill in these sections.
Field 5: Print the Plaintiff's name.
Field 6: Insert the index number.
Field 7: Print the Defendant's name.
Field 8: Insert the name, date of birth, social security number and mailing address of each unemancipated child of the marriage.
Field 9: Insert the name of the party who must enroll the child(ren) in the health insurance plan available through his or her employment.
Field 10: Insert the name of the party that has custody of or is the legal guardian of the child(ren).
Field 11: Insert the name, address and identification number (if any) of the health plan.
Field 12: Insert the name and address of the administrator of the plan (if any).
Field 13: Describe the type of coverage provided by the plan. Give a detailed description.
Field 14: Leave this section unchanged.
Field 15: Insert the date the parties agree that coverage is to be effective. If not filled in, the court will enter the date the order is signed.
Field 16: The court will fill in this section.