Medical Support

Medical support is a form of child support that provides either cash medical support or health insurance. Cash medical support is ordered on the Income Withholding Order for Support (IWO) order/notice. Child support agencies send a National Medical Support Notice (NMSN) to the employer to order health insurance coverage for an employee’s child(ren).

For more information, see Medical Support for Employers.

What to do when you receive the NMSN ordering health coverage

  • Step 1: Determine whether any of the four criteria on the Employer Response apply to you or this employee that prevent you from honoring the NMSN. You may only be able to determine the first three at this stage.
  • Step 2: If any apply, 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.
  • Step 3: The plan administrator will notify you when enrollment is complete. You must then notify your payroll department to make the appropriate deductions from the employee’s income.

Remember that the Consumer Credit Protection Act (CCPA) limits apply and that if there is insufficient allowable disposable income to withhold the amount ordered plus health insurance, you must check the law of your employee’s work state for priorities of different types of child support.  Priorities and CCPA limits for every state are available in the income withholding matrix

  • Step 4: If you determine that the amount of support plus the deduction for health care premiums exceeds the maximum deduction allowed, you must look to state law in the state where the employee is employed to determine the priority for payment. If the CCPA limits are too high for payment of ongoing support and health care premiums and the priority scheme does not allow for the payment of the health care premium first, you must complete No. 4 on the Employer Response form to notify the issuing agency that the employee’s children cannot be added.
  • Step 5: If enrollment cannot be completed until after a waiting period or other requirement, the plan administrator must process the enrollment at the end of that period.

To help understand the above steps, please see the NMSN process flowchart

What to do when you receive the NMSN terminating health coverage

Using the NMSN as a health coverage termination order or notice is optional for child support agencies.  If you receive an NMSN with the termination box checked at top, you may terminate the coverage for named children unless the employee voluntarily wishes to continue the coverage. 

For additional information, check out these questions and answers about medical support and the matrix of state-specific contacts and requirements for employers.

Qualified Medical Child Support Order (QMCSO)

An appropriately completed NMSN is considered a QMCSO and must be honored by all employers’ group health plans. A QMCSO 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.
  • The period for which the order applies.

For more information on QMCSOs, please see the Compliance Guide for Qualified Medical Child Support Orders (PDF) Visit disclaimer page

NMSN forms and instructions

Child support agencies send a National Medical Support Notice (NMSN) to the employer to order health insurance coverage for an employee’s child(ren).  Employers must honor this notice.

Current as of: