Medical Child Support Order



Medical Child Support Orders (MCSOs)

A 1993 amendment to the Employee Retirement Income Security Act (ERISA) requires employer-sponsored group health plans to extend health care coverage to children of an employee who is divorced, separated, or never married when ordered to do so by a court of competent jurisdiction or appropriate state agency.  Typically, this means the health plan of a child’s non-custodial parent must provide coverage to the child, even though the child may not meet the definition of a “dependent” under the plan’s eligibility rules.

Plans Covered

The MCSO provisions apply to “group health plans” subject to the Employee Retirement Income Security Act of 1974, as amended (ERISA).

For this purpose a “group health plan” generally is a plan that both:

“Medical care” means amounts paid for the diagnosis, cure, mitigation, treatment or prevention of a disease; for the purpose of affecting any structure or function of the body; transportation primarily for or essential to such care or services; or for insurance covering such care or services.

ERISA does not generally apply to plans maintained by: Federal, State or local governments; churches; and employers solely for purposes of complying with applicable workers compensation or disability laws. However, provisions of the Child Support Performance and Incentive Act (CSPIA) of 1998 require church plans to comply with QMCSOs and National Medical Support Notices, and State and local government plans to comply with National Medical Support Notices.

As a practical matter, most MCSOs and NMSNs are designed to cover an employee’s child under the employer’s major medical plan. But these orders may also require coverage under other types of group health plans, such as dental or vision plans, health FSAs, HRAs, or EAPs.

Qualified Medical Child Support Orders

If the employer determines these orders are qualified, they become Qualified Medical Child Support Orders (QMCSOs) and authorize coverage for the child (often referred to an alternate recipient)

Definition of Qualified Order

Any judgment, decree or order that is issued by a court of competent jurisdiction or an administrative agency authorized to issue child support orders under State law (such as a State child support enforcement agency) and that provides for medical support of a child is a medical child support order.

A medical child support order must contain the following information in order to be qualified:

An order may not require a plan to provide any type or form of benefit, or any option, not otherwise provided under the plan, except to the extent necessary to meet the requirements of applicable State laws.


A Plan’s QMCSO procedures must be disclosed in the SPD or include a statement that participants and beneficiaries may obtain a copy of a group health plan’s QMCSO procedures from the Plan Administrator, free of charge.

The Plan must establish reasonable procedures in order to determine whether medical child support orders are QMCSOs.

The Plan Administrator of the group health plan is required to determine whether an order is qualified.

The Plan Administrator must notify the participant and the alternate recipient upon receipt of a medical child support order.


A National Medical Support Notice (NMSN) is a standardized medical child support order that is used by state child support enforcement agencies. NMSNs must be issued in a standard format and includes instructions for the employer to follow.

NMSN Forms and Instructions

Additional Resources

Click Here for the Compliance Guide for Qualified Medical Child Support Orders.

Click Here for a Legal Definition of QMCSO.