Notice Concerning Continuation of Health Care Coverage
New York Supreme Court · Family Law
Copy of the court's form from nycourts.gov, taken October 21, 2026. See it on the court's site ↗
Notice required by Domestic Relations Law §255(1), served in a divorce, warning both spouses that once the judgment is signed they may lose coverage under each other's health insurance plan.
This form must be printed and filled by hand, or opened in Adobe Acrobat.