To help obtain health care coverage for children, State and
Federal laws mandate the use of the National Medical Support Notice
(NMSN). An appropriately
completed NMSN is considered to be a "Qualified Medical
Child Support Order," or QMCSO, and as such must be honored by the
employer's group health plan.
The NMSN complies with section 609 (a)(3) and (4) of ERISA,
which pertains to informational requirements and restrictions against
requiring new types or
forms of benefits. It also includes:
- applicable state law provisions for withholding employee
contributions due under any group health plan in connection with
coverage required to be provided;
- duration of the withholding requirement;
- applicability of limitations on such withholding under
Title III of the Consumer Credit Protection Act (CCPA), or similar state
law;
- the name and telephone number of the appropriate unit or division to contact at the state agency regarding the NMSN.
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 just that, your opportunity to respond to the request if one of the following situations exists:
- You do not provide health care coverage for your employees.
- The employee is not eligible for the health care coverage you provide.
- The employee has been terminated or has left this employment.
- The deduction for health care coverage cannot be
made because of state or federal withholding limits. These limitations
will be included in the
instructions for completing the NMSN.
- 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.
The plan administrator must send a copy of all health
insurance information necessary to access benefits to the custodial
parent including health
plan identification cards and claim forms if applicable.
The employer must notify the issuing agency if the employment or health care coverage stops.
The National Medical Support Notice - OMB-0970-0222 form may be accessed on the internet at https://www.acf.hhs.gov/css/resource/national-medical-support-notice-form
What to do when you Receive a NMSN:
- 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.
- 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.
- The plan administrator will notify you when enrollment
has been completed. You must then notify your payroll to make the
appropriate 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.
- If, in fact you determine that the amount of support
coupled with the deduction for health care premiums exceeds the maximum
deduction allowable, you must
look to state law in the state where the employee is
employed to determine the priority for withholding of the payment
allowable (in the state of Nevada that
limit is 50% of the employees aggregate disposable
income).
The Nevada Child Support Enforcement Program adopted a
state regulation, effective October 1, 2007,
regarding income withholding hierarchy; please see the
regulation below under the section titled Employer Responsibilities. If
the CCPA limits preclude payment
of ongoing support and health care premiums you must
notify the issuing agency by completing No. 5 on the Employer Response
form and send the form to the
requesting child support agency within 20 days.
- 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. In order to be "qualified", a
medical support order must clearly specify:
- the name and last known address of the participant and the name and address of each child covered by the order;
- a reasonable description of the coverage to be provided, or the manner in which coverage will be determined; and
- the period for which the order applies.
State laws require that health care coverage be provided under a medical support order even if the child:
- was born out of wedlock,
- is not claimed as a dependent for tax purposes, or
- does not reside with the parent or in the insurer's service area.
Instructions to Employer:
This document serves as notice that the employee identified
on this National Medical Support Notice is obligated by a court or
administrative child support
order to provide health care coverage for the child(ren)
identified on this Notice. This National Medical Support Notice replaces
any Medical Support Notice
that the Issuing Agency has previously served on you with
respect to the employee and the children listed on this Notice. If the
employee already has enrolled
the child(ren) in health care coverage, the employer should
contact the issuing agency to provide coverage information.
The document consists of Part A - Notice to Withhold for
Health Care Coverage for the employer to withhold any employee
contributions required by the group
health plan(s) in which the child(ren) is/are enrolled; and
Part B - Medical Support Notice to the Plan Administrator , which must
be forwarded to the
administrator of each group health plan identified by the
employer to enroll the eligible child(ren), or completed by the
employer, if the employer serves as
the health plan administrator.
Employer Responsibilities:
- If the individual named above is not your employee, or
if family health care coverage is not available, please complete items
1, 2, 3, 4, 5 of the
Employer Response as appropriate, and return it to the
Issuing Agency. NO FURTHER ACTION IS NECESSARY.
- If family health care coverage is available for which the child (ren) identified above may be eligible, you are required to:
- Transfer, not later than 20 business days after
the date of this Notice, a copy of Part B - Medical Support Notice to
the Plan Administrator
to the administrator of each appropriate group
health plan for which the child(ren) may be eligible, and
- Upon notification from the plan administrator(s)
that the child(ren) is/are enrolled, either: withhold from the
employee's income any employee
contributions required under each group health
plan, in accordance with the applicable law of the employees principal
place of employment and
transfer employee contributions to the appropriate
plan(s), or complete item 5 of the Employer Response to notify the
Issuing Agency that
enrollment cannot be completed because of
prioritization or limitations on withholding.
- If the plan administrator notifies you that the employee
is subject to a waiting period that expires more than 90 days from the
date of its receipt
of Part B of this Notice, or whose duration is determined
by a measure other than the passage of time (for example, the
completion of a certain
number of hours worked), notify the issuing agency of the
enrollment timeframe and notify the plan administrator when the
employee is eligible to
enroll in the plan and that this Notice requires the
enrollment of the child(ren) named in the Notice in the plan.
Limitations on Withholding:
The total amount withheld for both cash and medical support
cannot exceed 50% of the employee's aggregate disposable weekly
earnings. The employer may
not withhold more under this National Medical Support Notice
than the lesser of:
- The amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C., section 1673(b));
- The amounts allowed by the State of the employee's
principal place of employment; or The Federal limit applies to the
aggregate disposable weekly
earnings (ADWE). ADWE is the net income left after making
mandatory deductions such as State, Federal, local taxes; Social
Security taxes; and Medicare
taxes. As required under section 2.b.2 of the Employer
Responsibilities on prior page, complete item 5 of the Employer Response
to notify the Issuing
Agency that enrollment cannot be completed because of
prioritization or limitations on withholding.
Priority of Withholding:
If withholding is required for employee contributions to one
or more plans under this notice and for a support obligation under a
separate notice and
available funds are insufficient for withholding for both
cash and medical support contributions, the employer must withhold
amounts for purposes of
cash support and medical support contributions in accordance
with the law, if any, of the State of the employee's principal place of
employment
requiring prioritization between cash and medical support.
The Nevada Child Support Enforcement Program adopted a state regulation
regarding an
income withholding hierarchy. Please allocate the funds
available according to the regulation below.
STATE REGULATION:
When there are insufficient funds available to meet the
employees contribution necessary for health coverage for the child(ren)
and also to comply with
any income withholding orders received by the employer, up
to the limits of the Consumer Credit Protection Act, 15 U.S.C. 1673 (b),
the employer shall
allocate the funds available in accordance with the
following priority, unless a court or administrative order directs
otherwise:
- Current child and spousal support;
- Health insurance premiums or current cash medical support;
- Arrearages; and
- Other child support obligations
If an employee has insufficient funds available to enroll
the child(ren) in the health insurance program due to the CCPA limits,
follow Section 2.b.2
of the Employer Responsibilities on the prior page and
complete item 5 of the Employer Response, and return the form to the
Issuing Agency advising
enrollment cannot be completed due to insufficient funds.
Duration of Withholding:
The child(ren) shall be treated as dependents under the
terms of the plan. Coverage of a child as a dependent will end when
similarly situated dependents
are no longer eligible for coverage under the terms of the
plan. However, the continuation coverage provisions of ERISA may entitle
the child to continuation
coverage under the plan. The employer must continue to
withhold employee contributions and may not disenroll (or eliminate
coverage for) the child(ren) unless:
- The employer is provided satisfactory written evidence that:
- The court or administrative child support order referred to above is no longer in effect; or
- The child(ren) is or will be enrolled in
comparable coverage which will take effect no later than the effective
date of dis-enrollment from the plan; or
- The employer eliminates family health coverage for all of its employees.
Possible Sanctions:
An employer may be subject to sanctions or penalties imposed
under State law and/or ERISA for discharging an employee from
employment, refusing to employ,
or taking disciplinary action against any employee because
of medical child support withholding, or for failing to withhold income,
or transmit such withheld
amounts to the applicable plan(s) as the Notice directs.
Sanctions or penalties may be imposed under State law
against an employer for failure to respond and or for non-compliance
with this Notice.
Notice of Termination of Employment:
In any case in which the above employee's employment
terminates, the employer must promptly notify the Issuing Agency listed
above of such termination.
This requirement may be satisfied by sending to the Issuing
Agency a copy of Part A with item 4 checked or any notice the employer
is required to provide under the
continuation coverage provisions of ERISA or the Health
Insurance Portability and Accountability Act.
Employee Liability for Contribution to Plan:
The employee is liable for any employee contributions that
are required under the plan(s) for enrollment of the child(ren) and is
subject to appropriate enforcement.
The employee may contest the withholding under this Notice
based on a mistake of fact (such as the identity of the obligor). Should
an employee contest the withholding
under this Notice, the employer must proceed to comply with
the employer responsibilities in this Notice until notified by the
Issuing Agency to discontinue withholding.
To contest the withholding under this Notice, the employee
should contact the Issuing Agency at the address and telephone number
listed on the Notice. With respect to
plans subject to ERISA, it is the view of the Department of
Labor that Federal Courts have jurisdiction if the employee challenges a
determination that the Notice
constitutes a Qualified Medical Child Support Order.
Contact for Questions:
If you have any questions regarding this Notice, you may
contact the Issuing Agency at the address and telephone number listed on
the notice.
Instructions to Plan Administrator:
This Notice has been forwarded from the employer identified
above to you as the plan administrator of a group health plan maintained
by the employer (or a group
health plan to which the employer contributes) and in which
the non-custodial parent/participant identified above is enrolled or is
eligible for enrollment.
This Notice serves to inform you that the non-custodial
parent/ participant is obligated by an order issued by the court or
agency identified above to provide
health care coverage for the child(ren) under the group
health plan(s) as described on Part B.
If the participant and child(ren) and their mailing
addresses
(or that of a Substituted Official or Agency) are identified
above, and if coverage for the child(ren) is or will become available,
this Notice constitutes a
"qualified medical child support order" (QMCSO) under ERISA
or CSPIA, as applicable. (If any mailing address is not present, but it
is reasonably accessible,
this Notice will not fail to be a QMCSO on that basis.) You
must, within 40 business days of the date of this Notice, or sooner if
reasonable:
Complete Part B - Plan Administrator Response - and send it to the Issuing Agency:
If you checked Response 2:
- Notify the
non-custodial parent/participant named above, each named child, and the
custodial parent that coverage of the
child(ren) is or will become available (notification of
the custodial parent will be deemed notification of the child(ren) if
they reside at the same address);
-
Furnish the custodial parent a description of the
coverage available and the effective date of the coverage, including, if
not already provided, a summary plan
description and any forms, documents, or information
necessary to effectuate such coverage, as well as information necessary
to submit claims for benefits;
If you checked Response 3:
- If you have not already done so, provide to the
Issuing Agency copies of applicable summary plan descriptions or other
documents that describe available
coverage including the additional participant
contribution necessary to obtain coverage for the child (ren) under each
option and whether there is a limited
service area for any option;
- If the plan has a default option, you are to
enroll the child(ren) in the default option if you have not received an
election from the Issuing Agency within
20 business days of the date you returned the
Response. If the plan does not have a default option, you are to enroll
the child(ren) in the option selected
by the Issuing Agency.
- If the participant is subject to a waiting period
that expires more than 90 days from the date of receipt of this Notice,
or has not completed a waiting period
whose duration is determined by a measure other
than the passage of time (for example, the completion of a certain
number of hours worked), complete Response
4 on the Plan Administrator Response and return to
the employer and the Issuing Agency, and notify the participant and the
custodial parent; and upon satisfaction
of the period or requirement, complete enrollment
under Response 2 or 3, and
- Upon completion of the enrollment, transfer the
applicable information on Part B – Plan Administrator Response to the
employer for a determination that the
necessary employee contributions are available.
Inform the employer that the enrollment is pursuant to a National
Medical Support Notice. (B) If within 40
business days of the date of this Notice, or sooner
if reasonable, you determine that this Notice does not constitute a
QMCSO, you must complete Response 5
of Part B - Plan Administrator Response and send it
to the Issuing Agency, and inform the non-custodial parent/participant,
custodial parent, and child(ren)
of the specific reasons for your determination. (C)
Any required notification of the custodial parent, child(ren) and/or
participant that is required may
be satisfied by sending the party a copy of the
Plan Administrator Response, if appropriate.
Unlawful Refusal to Enroll:
Enrollment of a child may not be denied on the ground that:
(1) the child was born out of wedlock;(2) the child is not claimed as a
dependent on the participant's Federal income tax return;
(3) the child does not reside with the participant or in the plan's
service
area; or (4) because the child is receiving benefits or is
eligible to receive benefits under the State Medicaid plan. If the plan
requires that the participant be enrolled in order for the
child(ren) to be enrolled, and the participant is not currently
enrolled,
you must enroll both the participant and the child(ren). All
enrollments are to be made without regard to open season restrictions.
Payment of Claims:
A child covered by a QMCSO, or the child's custodial parent,
legal guardian, or the provider of services to the child, or a
State agency to the extent assigned the child's rights, may
file claims and the plan shall make payment for covered benefits
or reimbursement directly to such party.
Period of Coverage:
The alternate recipient(s) shall be treated as dependents
under the terms of the plan. Coverage of an alternate recipient
as a dependent will end when similarly situated dependents
are no longer eligible for coverage under the terms of the plan.
However, the continuation coverage provisions of ERISA or
other applicable law may entitle the alternate recipient to continue
coverage under the plan. Once a child is enrolled in the
plan as directed above, the alternate recipient may not be disenrolled
unless
the plan administrator is provided satisfactory written
evidence that either:
- the court or administrative child support order referred to above is no longer in effect, or
- the alternate recipient is or will be enrolled in
comparable coverage which will take effect no later than the effective
date of disenrollment from the plan;
- The employer eliminates family health coverage for all of its employees; or
- Any available continuation coverage is not elected, or the period of such coverage expires.