The National Medical Support Notice (NMSN or MED5/MED5C)

Legal Authorities:

29 USC § 1169
42 USC § 666(a)(19) – Health Care Coverage
29 CFR § 2590 – Rules and Regulations for Group Health Plans, Qualified Medical Child Support Order
45 CFR § 160.103
45 CFR § 164.501
45 CFR § 164.512(a) and (d)(1)(iii)
45 CFR §§ 303.30, and 303.32
36 OS § 6058A
43 OS § 118.2(B)
OAC 340:25-5-171

What is the National Medical Support Notice (NMSN)?

The primary method for enforcing a medical support order is using the National Medical Support Notice (NMSN) (Within the OSIS system: MED5/MED5A/MED5C/ MED5CA/MED5IS/MED5IA).

The NMSN 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 for health care coverage 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 care coverage.
• The NMSN is used for when either a noncustodial parent (NCP) or a custodian (CP) has been ordered to provide health care coverage 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.

What is included in the NMSN?

The NMSN is four separate documents with instructions (MED5 series of documents):

1. Part A – Notice to Withhold for Health Care Coverage
   1. Completed by CSS and sent to the employer with the rest of the packet.
2. Part A Response – response from employer back to CSS to indicate the action taken on the NMSN. The possibilities are:
   1. The employee on the Notice has never been employed by that employer.
   2. The employer does not offer any employees the option of purchasing dependent or family health care coverage as a benefit of their employment.
   3. The employee is among a class of employees (for example, part-time or non-union) that are not eligible for family health care coverage under any group health plan maintained by the employer or to which the employer contributes.
   4. Health care coverage is not available because the employee is no longer employed by the employer.
   5. State or Federal withholding limitations and/or prioritization prevent the withholding from the employee’s income of the amount required to obtain health care coverage under the terms of the plan.
   6. The employee is subject to a waiting period of more than 90 days or has not completed a waiting period which is determined by some measure other than the passage of time such as the completion of a certain number of hours worked. At the completion of the waiting period, the Plan Administrator will process the enrollment.
   7. The employer forwards Part B to the Plan Administrator and lists the date it was forwarded.
3. Part B – Medical Support Notice to Plan Administrator.
   1. This document is forwarded by the employer on to the Plan Administrator to process.
4. Response to Part B – response back to employer from the Plan Administrator.
   1. The Plan Administrator lists the date Part B was received from the employer and whether the NMSN was determined to be a qualified medical child support order (QMCSO).
   2. If not a QMCSO, the Plan Administrator must list the reason it was determined to NOT be a qualified medical child support order.
   3. The Plan Administrator also describes if the child was enrolled and in what type of health care coverage enrollment occurred.
   4. If the employee has a waiting period that must be satisfied prior to enrollment eligibility, the Plan Administrator is required to enroll the child when the waiting period has expired.

How is the NMSN Used and Where is it Sent?

When a child support order includes a provision ordering a parent to provide health care coverage for a child, the NMSN is used to communicate that information to the parent’s employer.
The NMSN is sent to the employer of NCP or CP. The NMSN is NOT sent to the employer of a stepparent, biological parent (BP) who is not also the custodian (CP), or other third-party who is not specifically ordered to enroll a child in health care coverage. Additionally, the NMSN is NOT sent to the Department of Defense or any military branch. 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.

Some employers maintain separate addresses for Income Withholding Orders (IWOs) and the NMSN. Additionally, some group health plans are 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 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 federal Office of Child Support Enforcement website.

NMSN Employer Compliance

An employer or Plan Administrator is required to comply with the NMSN. Failure to do so can open the employer or Plan Administrator up to sanctions of $200.00 per month per child for each failure to comply with the requirements of the NMSN.

If an employer fails to respond to the NMSN within 40 business days after the date of the NMSN, it is appropriate to manually send the Employer Insurance Enrollment Demand Letter (MED6 or MED6C). This letter informs the employer compliance with the NMSN is required and they may be subject to sanctions for failure to comply.

If the employer continues to fail to comply, the State’s Attorney may initiate legal proceedings to request the court to fine employers and insurers when there is no response indicating full compliance with the requirements of the NMSN within 10 business days after the date of the non-compliance letter.

A NMSN would need to be served on the employer prior to sanctions being filed. If the employer or insurer complies with the requirements of the NMSN, CSS may dismiss the case against the employer or insurer.