Medical support order

9.12(1) Medical support order required. The court must enter an order for medical support as required by statute. For purposes of Iowa Code section 252E.1A, the Medical Support Table in rule 9.12(4) is established for use by the courts of this state in determining reasonable cost for a health benefit plan and a reasonable amount in lieu of a health benefit plan (cash medical support). If health care coverage is ordered, the reasonable cost amount calculated in rule 9.12(2) must be stated in the order. If cash medical support is ordered, it must be a sum certain dollar amount stated in the order and is an amount in addition to the child support amount. 9.12(2) Calculating “reasonable cost” of health insurance. Refer to the Medical Support Table in rule 9.12(4) to determine if the parent has health insurance available at “reasonable cost.” Find the appropriate cell for the parent’s net income (as determined by the guidelines) and for the correct number of children. Multiply the parent’s gross income by the percentage in that cell. If the amount is equal to or more than the cost of the child(ren)’s portion of the health insurance premium (family cost minus single cost), it is available at “reasonable cost.” 9.12(3) Calculating cash medical support. a. If neither parent has health insurance available at “reasonable cost,” and if appropriate according to Iowa Code section 252E.1A, the court must order cash medical support. b. Refer to the Medical Support Table in rule 9.12(4) to determine the amount of cash medical support. Find the appropriate cell for the parent’s preliminary net income (gross income minus all appropriate deductions other than cash medical support in the pending matter) and for the correct number of children. Multiply the parent’s gross income by the percentage in that cell to get the cash medical support amount. c. For minimum orders in low-income Area A, cash medical support is not ordered. d. Cash medical support is not ordered if a parent is ordered to provide health insurance and that parent or stepparent of the child(ren) has obtained insurance coverage for the child(ren). e. If the child(ren)’s health care coverage is through the Healthy and Well Kids in Iowa program (Hawki) under Iowa Code chapter 514I, the ordered amount of cash medical support is the cost of the Hawki premium or the amount calculated pursuant to the Medical Support Table in rule 9.12(4), whichever is less. f. Use the adjusted net income (preliminary net income minus the amount of cash medical support in the pending matter) for the correct number of children on the Schedule of Basic Support Obligations to find the appropriate amount of child support. Once the adjusted net income has been determined, do not allow another deduction for cash medical support. December 2025 CHILD SUPPORT GUIDELINES Ch 9, p.7 9.12(4) Medical Support Table. Ch 9, p.8 CHILD SUPPORT GUIDELINES December 2025 9.12(5) Uncovered medical expenses. For purposes of this rule, “uncovered medical expenses” means all medical expenses for the child(ren) not paid by insurance. a. In cases of joint physical care, the parents will share all uncovered medical expenses in proportion to the parents’ respective net incomes. b. In all other cases, including split or divided physical care, the custodial parent will pay the first $250 per calendar year per child of uncovered medical expenses up to a maximum of $800 per calendar year for all children. The parents will pay in proportion to their respective net incomes uncovered medical expenses in excess of $250 per child or a maximum of $800 per calendar year for all children. c. For purposes of this rule, medical expenses include, but are not limited to, costs for reasonably necessary medical, orthodontia, dental treatment, physical therapy, eye care (including eye glasses or contact lenses), mental health treatment, substance use disorder treatment, prescription drugs, and any other uncovered medical expense. d. Uncovered medical expenses are not to be deducted in arriving at net income. e. Rule 9.12(5) will not apply when the support payee is a nonparent caretaker and only one parent is joined as a party to the pending action. f. Any variance from rule 9.12(5) must be supported by written findings in accordance with