National Medical Support Notice FAQs
We completed and mailed a NMSN response. The post office returned it. What do we do now?
Thank you for completing the NMSN. Our process changed at the end of April 2014. Please call customer service at 800-332-6347 to obtain the new mailing address.
Are medical support premiums deducted by the employer from the employee’s pay subject to the Consumer Credit Protection Act (CCPA) limits?
Yes, payments deducted from an employee’s pay for enrollment in medical insurance because of a National Medical Support Notice (NMSN) are usually subject to CCPA limits. State law governs whether priority should be given to ongoing cash child support or health care premiums. In Maryland, the priority of withholding is current child support first, then arrears, health insurance premiums, and cash medical support.
We enforced a National Medical Support Notice (NMSN) for one of our employees to cover his children. He is now terminated and only elected the Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage for himself. Should we require him to elect COBRA for the children as well?
Yes. A child(ren) covered by a group health plan pursuant to a NMSN is a beneficiary under the plan. The child(ren) covered is therefore a “qualified beneficiary” with the right to elect continued coverage under COBRA if the plan is subject to COBRA and if the child loses coverage as a result of a qualifying event.
I received a National Medical Support Notice (NMSN) for one of my employees, requesting enrollment in medical care and release of private medical information. Does the release of this information violate the Health Insurance Portability and Accountability Act (HIPAA)? What should I do?
The Privacy Rule (at 45 CFR 164.512(f)) permits a health plan to respond to a request for information by a child support agency issuing an NMSN. An employee of a child support agency, who is acting in accordance with state or federal law to enforce a medical child support order, meets the definition of a “law official” in the Privacy Rule. The NMSN sent by the agency to the employer and medical plan administrator for completion is considered a written administrative request by a law official. The Privacy Rule allows a medical plan administrator to disclose protected health information in response to the NMSN, which by law provides the written assurances.
Does the National Medical Support Notice (NMSN) apply to unions which provide insurance coverage to members, either as a benefit upon payment of union dues or available at a group rate to members who choose to enroll?
Yes. If an employer receives a NMSN for an employee who is a union member, the employer should forward the NMSN to the union.
If the employer has multiple coverage options, and the employee refuses to change his current coverage to provide medical support for a child(ren), can the plan administrator change the employee’s coverage to a different option where family coverage is available or where the premiums are lower and can be deducted within the Consumer Credit Protection Act (CCPA) limits even if it compromises the employee’s coverage?
Yes, the plan administrator may take whatever steps necessary to enroll the child(ren) named in the National Medical Support Notice.
What is the National Medical Support Notice (NMSN) and what does it include?
The National Medical Support Notice (NMSN) is a notice sent to employers from a child support agency. Its purpose is to ensure that children receive health care coverage when it is available and required as part of a child support order. It is designed to simplify the work of employers and plan administrators by providing uniform documents requesting health care coverage. The NMSN is divided into Part A and Part B. Part A is a Notice to Withhold for Health Care Coverage, the Employer’s Response, and Instructions. Part B is a Medical Support Notice to the Plan Administrator, the Plan Administrator’s Response, and Instructions.
What should I do if an employee is no longer eligible for employer-sponsored medical insurance coverage?
If your employee had coverage for the children and then is no longer eligible for coverage (for example, the employee has been terminated or his/her work status has changed to part-time or independent contractor), the employee and the children may be eligible for Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage. Any dependents not covered by the original benefits would not be eligible for COBRA coverage. If the provider of medical insurance changes, you should notify the child support agency. If you receive a National Medical Support Notice for an employee who is no longer eligible for medical insurance coverage, you should complete the Employer Response and return it to the child support agency.
What should I do if an employee no longer makes enough money to continue employer-sponsored medical insurance coverage?
If the employer cannot withhold the medical insurance premiums from an employee’s pay, it is the employee’s responsibility to provide medical insurance coverage a different way such as enrolling in a health exchange, obtaining private coverage, enrolling his/her child in a State Child Health Insurance Program (SCHIP), or to notify the child support agency and seek a modification of his/her medical support order.
When is the National Medical Support Notice (NMSN) sent to the employer?
The NMSN is sent when a new child support order is issued that requires a parent to provide medical coverage, when an existing order is modified, or when there is a new employer. It may also be sent in an existing case where it is not clear that the parent is complying with an order to provide coverage.
Who can I contact in my state with questions about a National Medical Support Notice (NMSN)?
For additional questions contact the DHS Help Line at 800-332-6347.