NMSN

Overview

The National Medical Support Notice (NMSN) is used by State child support enforcement agencies to secure coverage for children under their noncustodial parents’ group health plans. The Child Support Performance and Incentive Act of 1998 (CSPIA) requires health plans, including those sponsored by churches and State and local governments to provide benefits in accordance with the requirements of an appropriately completed NMSN.

NMSN Forms and Instructions

The NMSN is comprised of:

• Part A, Notice to Withhold for Health Care Coverage (which includes an Employer Response); and
• Part B, Medical Support Notice to Plan Administrator (which includes a Plan Administrator Response).

Employer’s Obligations

Ordinarily, an employer may expect to receive a NMSN when a child support enforcement agency initially enforces an employee’s medical support obligation, or when an employee with a previously established medical support obligation is newly hired.

Determine if Coverage Can be Provided

1) If the employer cannot provide coverage because:

• • The employee named in the NMSN is not an employee of the Employer;
  • The employer does not maintain or contribute to a plan that provides dependent coverage;
  • The named employee is among a class of employees (e.g. part-time or non-union) not eligible for enrollment in a plan that provides dependent coverage; or
  • The necessary employee contributions cannot be withheld from wages.

The employer must check the appropriate box on the Employer Response and return it to the issuing agency within 20 business days after the date of notice indicated on the NMSN.

2) If the employer can provide coverage, it must transfer Part B of the NMSN to the Plan Administrator (note that an employer is typically the plan administrator for the plans it sponsors) of the group health plans for which the child may be eligible for enrollment not later than 20 business days after the date of notice indicated on the NMSN. The employer retains Part A.

Determine Withholding Amounts

If the NMSN is qualified, the employer must determine:

1) If necessary employee contributions may be withheld from the employee’s wages without violating any applicable withholding limits. Part A of the NMSN contains information for the employer regarding Federal and State limitations on withholdings, any applicable withholding prioritization laws, and the duration of the withholding obligation.

2) If withholding limits would prevent the employer from withholding the employee contributions necessary for coverage, the employer must use the Employer Response on Part A to notify the issuing IV-D Agency of its inability to withhold the necessary amounts.

If the amounts necessary for coverage may be withheld, then the employer must initiate such withholding and transmit the withheld amounts to the group health plan to pay for the child’s coverage.

Apply Waiting Periods (if necessary)

1) A medical child support order is not considered not qualified solely because the participant is subject to a waiting period (such as one requiring a certain number of months or hours worked).

2) A waiting period may, however, affect the procedures necessary for enrollment of the named child. In this case, the plan administrator waits until the expiration of the necessary time to enroll the child and notifies the employer of the need, if any, to withhold from the employee’s wages to provide such coverage.

Plan Administrator’s Obligations

Note: an employer is typically the plan administrator for the plans it sponsors.

Review the NMSN

A plan administrator who receives a National Medical Support Notice from the employer must:

• Review the NMSN and determine whether it is appropriately completed;
• Complete the Plan Administrator Response (included with Part B of the NMSN), indicating whether the NMSN is a “Qualified” Medical Child Support Order (QMCSO);
• Return it to the State agency that issued the NMSN within 40 business days after the date of notice on the NMSN.

Administer Coverage

If the plan administrator determines that the NMSN is appropriately completed, the administrator is required to treat the NMSN as a “Qualified” Medical Child Support Order (QMCSO) and must:

• Inform the State agency that issued the NMSN when coverage under the plan of the child named in the NMSN will begin.
• Provide the custodial parent of the child (or, in some cases, a named State official) with information about the child’s coverage under the plan, such as the plan’s summary plan description, any forms or documents necessary to make claims under the plan, etc.
• If the participant is not enrolled and there is more than one option available under the plan for coverage of the child, the plan administrator must also use the Plan Administrator Response to notify the agency of that fact, and inform them of the available options for coverage.
• If the agency does not then respond within 20 business days and the plan has a “default option,” the plan administrator may enroll the child in the default option.