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National Medical Support Notice (NMSN) - Rhode Island New Hire Reporting Directory
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National Medical Support Notice (NMSN)

  1. What is the National Medical Support Notice (NMSN)?
  2. What does the NMSN ask employers to do?
  3. Are employers and health plan administrators required to comply?
  4. What is included in the NMSN?
  5. What is the purpose of Part A of the NMSN?
  6. Who completes Part A of the NMSN?
  7. What is the purpose of Part B of the NMSN?
  8. Who completes Part B of the NMSN?
  9. How soon must both parts of the Notice be completed?
  10. When must health care coverage withholding start?
  11. What must the employer do once a notice is received from the plan administrator that the children are enrolled?
  12. What if the employee doesn't make enough to cover the regular child support amount and the medical coverage premiums?
  13. What if the employee doesn't want to enroll the child for medical coverage?
  14. When will health care coverage withholding stop?
  15. What is the duration of withholding?
  16. What if the employee is terminated?
  17. What can the employee do if the employee believes that a NMSN has been issued in error?
  18. If a union provides health care coverage, what should the employer do?
  19. Who may the employer or plan administrator contact with questions about NMSNs?

1. What is the National Medical Support Notice (NMSN)?

The National Medical Support Notice (NMSN) is a two-part, federally required form. It was designed to provide employers and plan administrators with a standardized set of forms, processes, and timeframes to streamline the work to enroll dependent children in employer-sponsored health care plans. The NMSN meets the requirements for a Qualified Medical Child Support Order (QMCSO) if the child support agency correctly completes it and if coverage for the child(ren) is or will become available. The NMSN is a QMCSO under the Employee Retirement Income Security Act (ERISA) section 609(a)(5)(s). The National Medical Support Notice encompasses a full set of instructions so that the employer can comply with the responsibilities as outlined in the law.

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2. What does the NMSN ask employers to do?

Employers and/or labor organizations doing business in the State of Rhode Island must:
  • Confirm that the employee is eligible for group health insurance benefits.
  • Forward instructions to enroll dependent(s) to the designated plan administrator within 20 business days.
  • After the plan administrator has completed enrollment, complete and return the Health Insurance Information form.
  • Report any interruption of health insurance benefits to the Rhode Island New Hire Reporting, Medical Support Unit as soon as possible.
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3. Are employers and health plan administrators required to comply?

Yes. Federal and state law requires all employers and plan administrators who offer dependent coverage to make health care coverage available to children of employees who are eligible and qualify for such coverage pursuant to a court order for medical support. The NMSN forms were developed for this purpose by the State and federal Departments of Health and Human Services and Labor in consultation with payroll professionals, as well as sponsors and administrators of group health plans.

Employers and plan administrators who fail to comply with the NMSN in a timely manner may be subject to court actions by either the State or the parents of the dependent(s).

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4. What is included in the NMSN?

Part A of the NMSN includes an Employer Information Sheet, the Notice to Withhold for Health Care Coverage, the Employer Response form, and the Instructions.

Part B includes a Medical Support Notice to Plan Administrator, the Plan Administrator Response form, the NMSN Insurance Coverage Information Sheet, and the Instructions.

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5. What is the purpose of Part A of the NMSN?

Part A — Notice to Withhold for Health Care Coverage informs the employer of the type of coverage required under the order and the terms of coverage. The employer should complete and return Part A to the Rhode Island New Hire Reporting Portal only if one of the following federally mandated conditions for non-coverage exists:
  1. The employee named in the NMSN has never been employed by this employer.
  2. The employer does not maintain or contribute to plans providing dependent or family health care coverage to employees.
  3. The employee is among a class of employees (for example, part-time or non-union) that are not eligible for family health coverage under any group health plan maintained by the employer or to which the employer contributes. If the employee is only temporarily ineligible for health care coverage, do not check this box.
  4. Health care coverage is not available because the employee is no longer employed by this employer.
  5. State or Federal withholding limitations and/or prioritization prevent withholding from the employee's income of the amount required to obtain coverage under the terms of the plan (i.e., the reasonable cost of insurance coverage is less than or equal to 5% of the employee's gross monthly income).
  6. Other (new job information for employee, child adequately covered by a third party, or another reason for no coverage).
If one of these six conditions is not met, the employee's dependent(s) must be enrolled in the employer-provided health care plan.

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6. Who completes Part A of the NMSN?

The employer completes Part A indicating whether the employee is eligible for dependent health care coverage. If the employer determines the employee is eligible, the employer retains Part A and forwards Part B to the plan administrator.

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7. What is the purpose of Part B of the NMSN?

Part B — Medical Support Notice to Plan Administrator applies if the dependent is eligible for coverage. The NMSN is forwarded to the insurance Plan Administrator, who has 40 days from the date of the Notice to complete and return a response. The Plan Administrator must also notify the employer's payroll department of enrollment so that premiums are deducted, and forward insurance cards and plan information to the custodial parent identified on Part B of the NMSN.

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8. Who completes Part B of the NMSN?

The plan administrator completes Part B. Once the dependent(s) enrollment is complete, the plan administrator notifies the Rhode Island New Hire, Medical Support Unit and the employer so health care coverage premium deductions, if required, can begin. The plan administrator is the person or entity responsible for enrolling participants in a health care coverage plan.

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9. How soon must both parts of the Notice be completed?

Within 20 days of receipt of the NMSN, the employer must:
  • Complete Part A and either forward Part B to the Plan Administrator or submit Part A to the Rhode Island New Hire Reporting Portal.
Within 40 days of the issue date of the NMSN, the Plan Administrator must:
  • Complete and return Part B to the Rhode Island New Hire Reporting Portal (if applicable).
  • Advise the employer to begin withholding.
  • Forward the insurance cards and plan information to the custodial parent identified on Part B of the NMSN.
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10. When must health care coverage withholding start?

The Notice to Withhold for Health Care Coverage (Part A) requires withholding for the cost of health care as soon as health insurance enrollment information is available to the employer. The employer will determine whether the combined cost of cash support and health care coverage is within the limits of withholding. Limits are determined by RI Gen Laws 15-16-5 et seq.

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11. What must the employer do once a notice is received from the plan administrator that the children are enrolled?

If the amount is determined to be within the legal limits, the employer will begin withholding the contribution from the employee's wages.

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12. What if the employee doesn't make enough to cover the regular child support amount and the medical coverage premiums?

The employer should check Box 5 of the Employer Response (Part A), complete the Employer Information Sheet, and submit both to the Rhode Island New Hire Reporting Portal. If multiple coverage options are available to the employee and some would result in a violation of State or Federal withholding limitations, the employer must advise the Plan Administrator to enroll the dependent(s) in the option that is within allowable limits. For additional information on the application of CCPA limitations, please review the Federal Wage Garnishment Law, Consumer Credit Protection Act's Title III (CCPA) fact sheet as published by the U.S. Department of Labor, Wage and Hour Division. Alternatively, we suggest consulting with your legal counsel.

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13. What if the employee doesn't want to enroll the child for medical coverage?

The National Medical Support Notice is a Qualified Medical Child Support Order (QMCSO); therefore, the employee does not have a choice. If health care coverage is available, the employer is required to enroll the child or children as instructed in the NMSN. However, the employer must adhere to limitations imposed on withholding as mandated by withholding laws of the state where the employee is principally employed.

If the employee has a dispute with the enforcement of the QMCSO, the employee should reference the Employee Notice letter that was received with the NMSN, which details how to contact the local child support office and/or the Family Court that issued the order to provide coverage, as well as review any information provided in the employee letter sent by the employer. The employer must still comply with the NMSN regardless of whether a dispute has been made.

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14. When will health care coverage withholding stop?

The withholding order for health care coverage remains in effect until the employer is notified by the issuing local child support agency or receives a court order regarding any changes.

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15. What is the 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 conditions for eligibility for coverage under the terms of the plan no longer apply. 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:
    1. The court or administrative child support order referred to in this Notice is no longer in effect; or
    2. The child(ren) is or will be enrolled in comparable coverage that will take effect no later than the effective date of disenrollment from the plan; or
  • The employer eliminates family health care coverage for all its employees; or
  • Any available continuation coverage is not elected, or the period of such coverage expires.
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16. What if the employee is terminated?

In any case in which the employee's employment terminates, the employer must promptly notify the Issuing Agency of such termination. This requirement may be satisfied by submitting to the Rhode Island New Hire Reporting Portal a copy of Part A – Notice to Withhold for Health Care Coverage, with Section 1, 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. If known, the employer may also provide the new employer's name and address, as well as any other provider of a health benefit plan. The employer is also required to report the employee as a new hire if the employee returns to work.

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17. What can the employee do if the employee believes that a NMSN has been issued in error?

The employee should reference the Employee Notice letter that was received with the NMSN, which details how to contact the local child support office and/or the Family Court that issued the order to provide coverage. However, the employer must continue to comply with the employer's responsibilities under the NMSN until notified otherwise.

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18. If a union provides health care coverage, what should the employer do?

The employer should consider the union as the Plan Administrator and forward Part B of the NMSN to the union, unless the employer checks numbers 1, 2, or 3 in Part A of the NMSN Employer Response.

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19. Who may the employer or plan administrator contact with questions about NMSNs?

Employers and plan administrators may contact the Rhode Island New Hire Reporting, Medical Support Unit at (888) 870-6461, Ext. 400.

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