An Overview of the National Medical Support Notice (NMSN)

The National Medical Support Notice (NMSN) is made up of four documents:

  1. Part A - Notice to Withhold for Health Care Coverage: Completed by the child support agency and sent to the employer.
  2. Employer Response: Filled out by the employer and sent to child support agency if it cannot enroll the child in health insurance (e.g., employer does not provide health insurance to dependents, individual has been terminated from employment, etc.). 
  3. Part B - Medical Support Notice to Plan Administrator: Sent by the employer to its health plan administrator if child can be enrolled in health insurance.
  4. Plan Administrator Response: Completed by plan administrator and returned to the child support agency.

An Employer's Responsibility upon Receiving a NMSN

Step 1: Determine whether any of the first four options on the Employer Response form apply.

Step 2: If one of the four options applies, complete the Employer Response form and return it to the child support agency within 20 business days. If none of the four options applies, forward Part B to the company's health plan administrator.

Step 3: The plan administrator will notify the employer when enrollment has been completed. At that point, the employer must notify its payroll group to begin deducting the employee contribution for the health plan. At this point, the employer also may determine that the total deductions exceed the maximum allowed under the Consumer Credit Protection Act (CCPA) and any applicable state law.

Step 4: If the amount of support, coupled with the health care premium deductions, exceeds the maximum deduction allowable, the employer must check the law in the state where the person is employed to determine the priority for payment. If CCPA limits preclude payment of ongoing support and health care premiums and the priority scheme does not allow for the payment of the health care premium first, the employer must notify the child support agency using the Employer Response form.

Step 5: If enrollment cannot be completed until after a waiting period or other contingency, the employer must notify the plan administrator when the employee becomes eligible for enrollment.