How Should Employers Handle a National Medical Support Notice?

A National Medical Support Notice (NMSN) is the federal form that child support agencies use to order an employer to enroll an employee's child in employer group health coverage. Cash medical support is ordered on the income withholding form instead. The rules are at 45 CFR 303.32 and, for group health plans, section 609 of ERISA at 29 U.S.C. 1169.

When the notice arrives. Under 45 CFR 303.32(c)(2), the state agency must send the NMSN to the employer within two business days after it enters a new hire record for an employee who owes support in a child support case. The notice replaces any earlier medical support notice for the same employee and children.

Two parts. Part A is the Notice to Withhold for Health Care Coverage, which directs the employer to withhold employee contributions. Part B is the Medical Support Notice to the Plan Administrator.

Employer steps. OCSS guidance lays out the process:

• Check whether any of the four conditions on the Employer Response form apply that prevent the employer from honoring the notice. Some may not be known until the plan reviews the notice.
• If one applies, return the Employer Response to the issuing agency within 20 business days.
• If none applies, send Part B to the plan administrator within 20 business days after the date of the notice.
• After the plan confirms enrollment, withhold the employee contributions and send them to the plan.

Plan administrator duties. An appropriately completed NMSN is treated as a qualified medical child support order. Within 40 business days after the date of the notice, the plan administrator must tell the state agency whether coverage is available and, if so, whether the child is covered and the coverage start date (29 U.S.C. 1169). If enrollment must wait for a waiting period, the administrator processes it when the period ends.

Withholding limits. Consumer Credit Protection Act limits still apply. If cash support plus premiums would exceed the maximum, the employer follows the priority rules of the state where the employee works, and may need to tell the agency that the children cannot be added.

Contests and terminations. An employee may contest the withholding based on a mistake of fact, but the employer must start withholding until it receives notice that the contest is resolved. The employer must notify the state promptly when the employment ends, the same way it does for income withholding.

Related topics. The FAQ on child support income withholding orders covers the wage side of a support order. Program changes are covered in the Learn Laws® news item on the child support deregulation proposal. Benefits teams that handle protected health information should also review whether HIPAA training is mandatory.