Medical Support

What Employers Need To Know 

The Child Support Services Division (CSSD) uses the National Medical Support Notice (NMSN) to order health care coverage. The NMSN is a standardized federal form that all state child support agencies must use. The form was developed with input from employer groups and health plan administrators. 

The NMSN is actually four documents and instructions:

Part A- Notice to Withhold For Health Care Coverage, will be completed by the child support agency and sent to the employer with the rest of the packet.

"Employer Response" is your opportunity to respond to the request if one of the following situations exists:

  1. You do not provide health care coverage for your employees.
  2. The employee is not eligible for the health care coverage you provide.
  3. The employee has been terminated or has left this employment.
  4. The deduction for health care coverage cannot be made because of State or Federal withholding limits and the State's priority for withholding. These limitations will be included in the instructions that accompany the NMSN or that you have received from your State, as mentioned above.

Otherwise, follow the steps below to comply with the NMSN.

  • Part B- Medical Support Notice To Plan Administrator. This document should be forwarded to your health care plan administrator for handling.
  • "Plan Administrator Response" is completed by your Plan Administrator according to the accompanying instructions and returned to the child support agency.

Step-By-Step: What To Do When You Receive a NMSN

  • Step 1: Once you receive the NMSN, determine whether any of the four categories on the Employer Response apply to you or this employee. You may only be able to determine whether one of the first three apply at this stage.
  • Step 2: If so, complete the Employer Response form and return it to the Issuing Agency within 20 business days. If none of the four categories on the Employer Response apply to you or this employee, forward Part B to your plan administrator.
  • Step 3: The plan administrator will notify you when enrollment has been completed. You must then notify your payroll to make the deductions for employee contribution required under the health plan. It is at this point that you may determine that the total deductions exceed the maximum allowed under the Consumer Credit Protection Act (CCPA), and any applicable state law.
  • Step 4: If together the amount of support and the deduction for the premiums exceeds the maximum allowable deduction, at this point you must look to state law. The law of the state where the employee is employed is used to determine the priority for payment. 
  • Step 5: If enrollment cannot be completed until after a waiting period or other contingency, you must notify the Plan Administrator when the employee is eligible for enrollment.