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Child Support Enforcement

Employer Resources
     Medical Support

National Medical Support Notice 

The National Medical Support Notice (NMSN) is a standardized federal form that all state IV-D child support agencies must use. The form complies with section 609 (a)(3) and (4) of the Employee Retirement Income Security Act (ERISA).


Part A of the NMSN: Notice to Withhold for Health Care Coverage

Employer Response - If one of the following situations exist, answer and return to the Child Support Enforcement (CSE) unit:

  • 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 and/or the state’s priority for withholding. The limitations will be included in the instructions that come with the NMSN.

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

Part B of the NMSN: Medical Support Notice To Plan Administrator.

This document should be sent to your health care plan administrator for processing.

Plan Administrator Response - Should be completed by your plan administrator, according to the accompanying instructions, and returned to CSE.

Employer Responsibilities  Step-By-Step:

Determine if any of the four categories listed on the Employer Response apply to you or to the employee.

  1. If so, complete the Employer Response form and return it to CSE within 20 business days. If none of the four categories apply, forward Part B: Medical Support Notice to your plan administrator.
  2. Notify your payroll office or service to make the appropriate deductions for the employee contribution required under the health plan. At this point, you can determine whether the total deductions are greater than the maximum allowed under the Consumer Credit Protection Act (CCPA) and any applicable state law.
  3. If the amount of support, plus the deduction for health care premiums, exceeds the maximum deduction allowed, you must refer to state law where the employee is employed to determine the priority for payment.
  4. If enrollment cannot be completed until after a waiting period or other contingency, you must notify the plan administrator as to when the employee is eligible for enrollment.
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