National Medical Support Notice (NMSN): Frequently Asked Questions

The National Medical Support Notice (NMSN) is a two-part, federally-required form. It was designed to provide employers and plan administrators with a standardized set of forms, processes, and timeframes to streamline the work to enroll dependent children in employer-sponsored health care plans. The NMSN meets the requirements for a Qualified Medical Child Support Order (QMCSO) if the child support agency correctly completes it and if coverage for the child(ren) is or will become available. The NMSN is a QMCSO under the Employee Retirement Income Security Act (ERISA) section 609 (a)(5)(s).

The NMSN will typically be issued a few days following your receipt of an Order/Notice to Withhold Income for Child Support.

• Confirm that the employee is eligible for group health insurance benefits.
• Forward instructions to enroll to the designated plan administrator within 20 business days.
• After the plan administrator has completed enrollment, the Health Insurance Information form must be completed and returned to the National Medical Support Notice Center.
• Any interruption of health insurance benefits must be reported to the NJ NMSN Center as soon as possible.

Yes. Federal and state law requires all employers and plan administrators who offer dependent coverage to make health care coverage available to children of employees who are eligible and qualify for such coverage pursuant to a medical child support order, (See 29 USC 1169(a)). The NMSN forms were developed for this purpose by the federal Departments of Health and Human Services and Labor in consultation with payroll professionals, as well as sponsors and administrators of group health plans.

Employers and plan administrators who fail to comply with the NMSN in a timely manner may be subject to court actions by either the State or the parents of the dependent(s).

• Part A of the NMSN includes an Employer Information Sheet, the Notice to Withhold for Health Care Coverage, the Employer Response form, and the Instructions.
• Part B includes a Medical Support Notice to Plan Administrator, the Plan Administrator Response form, the NMSN Insurance Coverage Information Sheet, and the Instructions.

Part A — Notice to Withhold For Health Care Coverage informs the employer of the type of coverage required under the order and the terms of coverage. The employer should complete and return Part A to the NMSN Processing Center only if the following federally-mandated conditions for non-coverage exists:

1. The employee named in the NMSN has never been employed by this employer.
2. We, the employer, do not maintain or contribute to plans providing dependent or family health care coverage to our employees.
3. The employee is among a class of employees (for example, part-time or non-union) that are not eligible for family health coverage under any group health plan maintained by the employer or to which the employer contributes.
4. Health care coverage is not available because the employee is no longer employed by this employer.
5. State or Federal withholding limitations and/or prioritization prevent the withholding from the employee's income of the amount required to obtain coverage under the terms of the plan. If multiple coverage options are available to the employee and some of the options would result in a violation of State or Federal withholding limitations, the employer must advise the Plan Administrator to enroll the dependent(s) in the option that is within allowable limits.
6. If one of these five conditions is not met, the employee's dependent(s) must be enrolled in the employer-provided health care plan.

The employer completes Part A indicating whether the employee is eligible for dependent health care coverage. If the employer determines the employee is eligible, the employer retains Part A and forwards Part B to the plan administrator.

Part B — Medical Support Notice to Plan Administrator applies if the dependent is eligible for coverage. The NMSN is forwarded to the insurance Plan Administrator who has 40 days from the date of the Notice to complete and return to the NMSN Processing Center at PO Box 4655 , Trenton, NJ 08650. The Plan Administrator must also notify the employer's payroll department of enrollment so that premiums are deducted, and forward insurance cards and plan information to the custodial parent identified on Part B of the NMSN.

The plan administrator completes Part B. Once the dependent(s) enrollment is complete, the plan administrator notifies the NJ NMSN Center and the employer, so health care coverage premium deductions, if required, can begin. The plan administrator is the person or entity responsible for enrolling participants in a health care coverage plan.

Within 20 days of the NMSN receipt:

• The employer must complete Part A and either forward Part B to the Plan Administrator or return Part A to the NMSN Processing Center.

Within 40 days of the issue date of the NMSN, the Plan Administrator must:

• Complete and return Part B to the NMSN Processing Center (if applicable).
• Advise the employer to begin withholding.
• Forward the insurance cards and plan information to the custodial parent identified on Part B of the NMSN.

The Notice to Withhold for Health Care Coverage (Part A) requires withholding for the cost of health care as soon as health insurance enrollment information is available to the employer. The withholding deductions for both child support and health insurance premiums may not exceed 50-65 percent of the employee's net disposable income.

The employer will determine whether the combined cost of cash support and health care coverage is within the limits of withholding. Limits are determined by state law where the employee is principally employed.

If the amount is within the legal limits, the employer will begin withholding the contribution from the employee's wages.

The employer should check box 5 of the Employer Response (Part A), complete the Employer Information Sheet, and return both to the NMSN Processing Center. If multiple coverage options are available to the employee and some of the options would result in a violation of State or Federal withholding limitations, the employer must advise the Plan Administrator to enroll the dependent(s) in the option that is within allowable limits.

The National Medical Support Notice is a Qualified Medical Child Support Order (QMCSO); therefore, the employee does not have a choice. If health care coverage is available, the employer is required to enroll the child or children as instructed in the NMSN. However, the employer must adhere to limitations imposed on withholding as mandated by withholding laws of the state where the employee is principally employed.

If the employee has a dispute with the enforcement of the QMCSO, the employee should be directed to contact their local enforcement office. The employer must still comply with the NMSN regardless of whether a dispute has been made.

The withholding order for health care coverage remains in effect until the employer is notified by the issuing local child support agency or receives a court order regarding any changes.

The employer must notify the NJ NMSN Center promptly when the employee leaves, providing the termination date and the employee's last known home address. If known, the employer may also provide the new employer's name and address, as well as any other provider of a health benefit plan. The employer is also required to report the employee as a new hire if the employee returns to work.

Determining the best way to handle multiple orders can sometimes be complicated. If the employer has specific questions in regards to the Notice, the employer may contact the NJ NMSN Center at (800) 806-3621.

The employee may contact the local enforcement office to discuss the matter. However, the employer must continue to comply with the employer responsibilities under the NMSN until notified to discontinue withholding.

The employer should consider the union as the Plan Administrator and forward Part B of the NMSN to the union, unless the employer checks numbers 1, 2, or 3 in Part A of the NMSN Employer Response.

Employers and plan administrators may contact the NJ NMSN Center at (800) 806-3621.