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National Medical Support Notice, Employer Requirements

A National Medical Support Notice (NMSN) may be sent to you, if one of your employees has a child support obligation, by a state child support enforcement agency (CSEA). The NMSM is a standardized form that advises you when your employee has been ordered to provide health insurance coverage for a child through your company's health plan.

The NMSN is a federal form that all state child support enforcement agencies must use. If an order has been issued and health coverage is available through the employer, the child must be enrolled by the Plan Administrator.

The standardized NMSN does have some advantages for the employer:

  • It provides uniform documents so the employer does not have to learn 50 different forms and ways of doing the same thing.

  • The NMSN meets all ERISA requirements under section 609(a)(3) & (4) and is in fact a Qualified Medical Child Support Order.

  • It satisfies state law for withholding employee contributions for the child's health care coverage. It also sets up the priorities for withholding when withholding is inadequate to cover child support and a NMSN.

  • The NMSN states the duration of the medical support withholding and should have the name and address of a contact at the CSEA.

The NMSA consists of four documents.

  • Part A, " Notice to Withhold for Health Care Coverage"

  • Part B, Medical Support Notice to Plan Administrator"

  • Responses to Both Notices

The following five steps are a summary of what the employer is responsible to do under the NMSA without compensation for his time or trouble.

  • Step One: Determine if the NMSN really applies to you or an employee of yours under the four listed categories. If so complete the response portion and send it back to the CESA it came from.

  • Step Two: If none of the response categories apply send Part B of the form to your Plan Administrator.

  • Step Three: The Administrator should notify you when the enrollment is complete at which time you tell your payroll department or payroll service provider how much to deduct from the employee and on what basis.

  • Step Four: If the combination of the premium amount and the deduction for health care exceed the maximum allowable deduction the employer has to look at state law to determine the priority of the payments. If state law priorities keep the employer from paying the premium complete the Employer Response and send it to the CSEA.

  • Step Five: If enrollment for the child cannot be completed until a future date or until some other action takes place you need notify the Plan Administrator when the employee will be eligible to enroll. You should also notify the CSEA of the time frame involved.

About the Author: Charles J. Read, CPA has been in the payroll, accounting and tax business for 30 years, the last fifteen in private practice.
Mr. Read is the author of “How to Start a New Business.”

To find professional payroll service at a budget price go to a paperless payroll company.

For a full service payroll bureau with CPA’s on staff visit .

See an excerpt of Mr. Read’s interviews from William Shatners “Heartbeat of America” television show on the web sites linked above.

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