Health Insurance: National Medical Support Notice

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  • What is the National Medical Support Notice (NMSN)?
    • The National Medical Support Notice is a court order that requires the noncustodial parent’s employer (or other person providing health insurance) to enroll the child(ren) in the parent’s health insurance plan.
    • The order also authorizes the employer to deduct the cost of the health care premiums from the noncustodial parent's earnings.
  • What are my responsibilities as an employer?
    • To enroll the child(ren) if medical benefits are available at a reasonable cost. Reasonable cost can be defined as 5% of the noncustodial parents gross monthly income.
    • To enforce the National Medical Support Notice, even if the health benefits are paid through a union trust.
    • Employers must follow strict timelines to comply with the National Medical Support Notice.
    • Eligible employees do not have the option to refuse health insurance coverage.
    • The employer must notify the Department of Child Support Services (DCSS) of any lapse or change in the health insurance coverage.
  • How do I process the National Medical Support Notice?

    Within 20 business days of receipt of the NMSN, the employer:

    • Must forward the instruction to enroll to the designated plan administrator.
    • The employer must complete the Employer Response form and return it to the child support agency.
    • Paycheck deductions should begin within the first 30-day period of receiving the National Medical Support Notice. Employers may not deduct wages for a date prior to receipt of the Notice.

    Within 40 business days, the plan administrator or employer must provide the DCSS with:

    • Plan Administrator Response form
    • A description of the coverage available
    • The effective date of the coverage
    • A summary plan description
    • Any forms or documents
    • Any information necessary to submit claims for benefits
  • Should the health insurance enrollment include dental and vision insurance?

    Yes, the child(ren) should be enrolled in dental and vision insurance if it is available at no cost or at a reasonable cost. If cost exceeds 5% of the parents gross monthly income,  contact the DCSS for further review.

  • How does the custodial party get copies of the insurance cards?
    • If the medical insurance cards come directly to the employee, the employee should give the cards to the employer to forward to the custodial party or the the DCSS. DCSS will then forward the cards to the custodial party.
    • If the employer is not able to convince the employee to surrender the cards, then it becomes the employer’s responsibility to have the provider either send the cards directly to the employer or to DCSS.
    • When contacting the health care provider to request the medical insurance cards, you should include a copy of the court order and ask to speak to a supervisor or legal counsel. If these attempts are unsuccessful, contact DCSS.
  • What happens if the employee refuses to enroll?
    • Health insurance enrollment is court ordered. If the employee refuses to cooperate then the employer shall enroll the child(ren) without the employee’s assistance. The employee does not have to be involved. On the signature line of the enrollment forms write, “Per court order - copy attached.”
    • If the employee is not currently enrolled, and their enrollment is required to enroll the child(ren), then you will be required to enroll the employee.
  • What if the child resides out of state or out of the coverage area?

    If the child(ren) lives out of state or outside of the insurance coverage area, some insurance providers may have a “guest membership enrollment” available where insurance coverage may extend to another state. If the medical provider cannot cover an out of state child, please contact DCSS.