5101:12-57-99 Chapter 5101:12-57 forms - enforcement of medical support provisions.

 

 

 

5101:12-57-99             Chapter 5101:12-57 forms - enforcement of medical support provisions.

 

 

 

The forms identified in this rule are referenced within various rules contained within division 5101:12 of the Administrative Code. The effective or revised effective dates of the forms are as follows:

 

(A)JFS  03377,  "Employer/Health  Plan  Administrator  Health  Insurance  Verification Request" (rev. 9/2015);

 

(B)JFS 03399, "Notice of Administrative Mistake of Fact Hearing" (rev. 9/2015);

 

(C)JFS 04031, "Notice Regarding Cash Medical Support Order" (rev. 9/2015);

 

(D)JFS 04032, "Notice to Provide Cash Medical Support" (rev. 9/2015);

 

(E)JFS 04033, "Notice to Provide Private Health Insurance" (rev. 9/2015);

 

(F) JFS 04034, "Notice of Selection of Health Plan Option" (rev. 9/2015);

 

(G)JFS 04035, "Notice of Available Health Plan Options" (rev. 9/2015);

 

(H)JFS 04036, "Notice of Medical Support Enforcement Activity" (rev. 9/2015);

 

(I)JFS 04037, "Medical Support Enforcement Administrative Mistake of Fact Hearing Decision" (rev. 9/2015);

 

(J) JFS 04098, "Notice Regarding NMSN Withholding Requirements" (rev. 9/2015);

 

(K)JFS 07053, "Notice of Medical Support Mistake of Fact Hearing" (rev. 9/2015); and

 

(L)JFS 07058, "Medical Support Mistake of Fact Hearing Determination" (rev. 9/2015).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5101:12-57-99         Effective:		01/01/2015	2
Five Year Review (FYR) Dates:		01/01/2020
CERTIFIED ELECTRONICALLY
Certification
11/19/2014
Date
Promulgated Under:	119.03
Statutory Authority:	3125.25
Rule Amplifies:	3125.03