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Additional Health Insurance (Financial Affidavit)

Illinois · Illinois Supreme Court · Effective June 1, 2025

This form is an add-on sheet to a Financial Affidavit used to list details about extra health insurance coverage for yourself and your family. It asks for information like the insurance company's name, the type of coverage, and the monthly costs.

Open the official PDFfrom Illinois Supreme Court

Where this fits in a case

Motions

Stage: Motions

This form is used when the main Financial Affidavit form does not have enough space to list all the additional health insurance details.

Either party may file.

Official instructions

How-to guides published by the court for this form.

Common questions

Who must use this form?
This form is approved by the Illinois Supreme Court and must be used in all Illinois Circuit Courts.
What does this form ask for?
It asks for details about additional health insurance, including the company name, type of policy, and the total monthly cost.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect June 1, 2025.

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