Request and Notice of Hearing Regarding Health Insurance Assignment

Judicial Council of California · Family Law

Verified current as of August 1, 2026

This form is used to request a court hearing and notify the other parent that you want the court to order health insurance coverage for a child in a family law case. Parents or guardians use this form when they need the court to decide who should be responsible for providing and paying for a child's health insurance as part of custody, child support, or divorce proceedings.