Health Insurance

National Medical Support Notice

The National Medical Support Notice (NMSN) acts as a court order requiring the employer (or other entity providing health insurance) to enroll the employee’s child in the employer’s health insurance plan. The NMSN authorizes the employer to deduct the cost of the health insurance premium from the employee’s earnings. The NMSN also instructs the employer to notify us of any lapse or change in the employee’s health insurance coverage.

The employer is responsible for enforcing the NMSN. If the employer fails to enroll the employee's child in the health insurance plan (and provide us with coverage details), the employer may be subject to sanctions or penalties.

The employer must notify us if the employer does not offer health insurance coverage to employees or if an employee is not eligible for the coverage.

The employer must notify us within 10 business days of termination or cancellation of health insurance coverage.

Support obligors are required to provide medical insurance coverage (health, dental, and vision) for their children if coverage is available to them at no cost or a reasonable cost. Effective January 1, 2011, cost of insurance is considered reasonable if the cost for the child(ren) does not exceed 5% of the obligor's gross income. The cost for the children is the difference between self-only coverage and family coverage. The total cost of the insurance coverage and the cash support withheld may not exceed 50% of the employee’s net disposable earnings. If cash medical support is ordered, it is due in addition to the basic support order.

Employers have strict deadlines to comply with the National Medical Support Notice (NMSN).

  • Within 10 business days of receipt of the NMSN, the employer must: (1) notify the employee of the NMSN, (2) provide the employee with a copy of the NMSN and (3) provide the employee with a blank Request and Notice of Hearing Regarding Health Insurance Assignment.
  • Within 20 business days of receipt of the NMSN, the employer must forward the NMSN to the designated health insurance plan administrator. On verification of enrollment, the employer must complete the Medical Insurance Form (DHS 6110) and return it to us. Paycheck deductions should begin within the first 30-day period after receiving the NMSN.
  • Within 40 business days, the employer must provide us with:
    • A description of the coverage available
    • The effective date of the coverage
    • A summary plan description
    • Any forms or documents
    • Any information necessary to submit claims for benefits

The employee’s child should be enrolled in dental and vision insurance if it is available through the employer at a reasonable cost.

Effective January 1, 2011, medical coverage is defined as accessible if the coverage provides services within 50 miles of the supported child's residence.

Employers must assist the custodial party (CP) in obtaining all materials necessary to access the health care coverage. This includes all medical insurance cards and claim forms. If the employee fails or refuses to provide the CP with the medical card or other necessary forms, the employer should obtain the documents directly from the employee or the health care provider and forward them to the CP or to us so that we can provide them to the CP.

The employer should include a copy of the NMSN Parts A and B when requesting the medical insurance cards from the health insurance provider. We are available to assist employers that are unable to obtain medical insurance cards. For assistance, please Contact Us.

Health insurance enrollment is court ordered. As a condition for the child’s enrollment in the health insurance plan, the employer may require the employee to enroll. If the employee refuses to cooperate, then the employer may enroll the child without the employee’s assistance. On the signature line of the enrollment forms the employer should write, “Per court order - copy attached.” The employer or employee may Contact Us to discuss the cost of enrolling both the employee and the child.

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