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:

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 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.


If the employer offers a number of different types of benefits (e.g. dental, prescription) through separate plans, and the issuing agency has not specified which or all are covered by the NMSN, the employer should assume all plans are covered by the NMSN, and send copies of Part B of the NMSN to each plan administrator.

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:

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:

NMSN qualifying as a QMCSO

An “appropriately completed” NMSN satisfies the informational requirements of the QMCSO provisions by:

A NMSN also requires the plan to provide to a named child only those benefits that the plan provides to any dependent of a participant who is enrolled in the plan, and any other benefits that are necessary to meet the requirements of the State laws relating to medical child support.

Appropriately Completed NMSN

To be considered “appropriately completed” the NMSN must include the following information:

A NMSN may be “appropriately completed” even if some items of information in the NMSN are not included as long as the NMSN includes the information listed above. In addition, if any of the necessary information described above has been omitted but is reasonably available to the plan administrator, the NMSN should not fail to be “appropriately completed” solely because of such omission.