Application And Order For Health Insurance Coverage
Judicial Council of California · Family Law
Verified current as of August 1, 2026
This form allows a court to order one parent to provide health insurance coverage for their children as part of a family law case. Parents use it in custody, child support, or divorce cases to ensure children have medical insurance coverage by requiring the responsible parent to pay for it.
This form has fillable fields — you can complete it directly in the viewer on the right.