The primary method for enforcing a medical support order is using the National Medical Support Notice (NMSN) (MED5/MED5A/MED5C/ MED5CA/MED5IS/MED5IA). This is a federally required document used to provide a standardized means of communication between State child support agencies, employers, and administrators of group health plans regarding the medical support obligations of noncustodial parents and custodial persons.
The notice facilitates the process of enrolling children in group health plans for which their parents are eligible. The NMSN must be issued within two days of identifying an employer of a parent ordered to enroll a child in health insurance.
The NMSN is used for when either a noncustodial parent or a custodian has been ordered to provide health insurance for a child. An appropriately completed NMSN is considered a “Qualified Medical Child Support Order,” (QMCSO) and as such must be honored by all employers’ group health plans.
When a child support order includes a provision ordering a parent to provide health insurance for a child, the NMSN is used to communicate that information to the parent’s employer. It is sent to the employer of a noncustodial parent or a custodian.
The NMSN is NOT sent to the employer of a step-parent, biological parent who is not also the custodian or other third party who is not specifically ordered to enroll a child in health insurance. Additionally, the NMSN is NOT sent to the Department of Defense or any military branch.
The information on the NMSN is confidential and employers should be cautioned to NOT provide a copy of the NMSN to a noncustodial parent. When family violence has been indicated on an CSS case, the NMSN is produced with a substitute agency address instead of the custodian’s address to protect the location of the child(ren).
The MED5L screen is used to pull the NMSN (MED5) if CSS staff determines the document should not be sent out once it has been generated. There is a two-day window in which to pull the document.
The NMSN should be sent to the employer. Some employers maintain separate addresses for Income Withholding Orders (IWOs) and the NMSN. Additionally, some group insurance is provided through other organizations associated with the parent/employee such as a labor union.
While the employer is supposed to forward the NMSN to the appropriate Plan Administrator, a delay of twenty days can occur during this process. Addresses for NMSN submission should be forwarded to the Employer Services Center (ESC) to be included in OSIS to ensure the NMSNs are delivered to the appropriate location for each employer.
If the employer is a federal agency, send to the appropriate location as listed on the ACF website: Federal Employer Contact Listing.