The National Medical Support Notice (NMSN) is made up of four documents:

1. Part A- Notice to Withhold for Health Care Coverage.  Completed by the child support agency and sent to the employer.
2. Employer Response. Form filled out by employer and sent to child support agency if for some reason it can not enroll the child in health insurance (e.g. employer does not provide health insurance to dependents, individual has been terminated from employment, etc.). 
3. Part B- Medical Support Notice to Plan Administrator. If child can be enrolled in health insurance, the employer sends this document to the employer’s health care plan administrator.
4. Plan Administrator Response.  Completed by Plan Administrator and returned to the child support agency.

What to do when you receive a NMSN

Step 1: Determine whether any of the first four options on the Employer Response apply.

Step 2: If so, complete the Employer Response form and return it to the child support agency within 20 business days. If not forward Part B to your plan administrator.

Step 3: The plan administrator will notify you when enrollment has been completed. You must then notify your payroll to make the appropriate deductions for employee contribution required under the health plan. It is at this point that you may determine that the total deductions exceed the maximum allowed under the Consumer Credit Protection Act (CCPA), and any applicable state law.

Step 4: If you determine that the amount of support coupled with the deduction for health care premiums exceeds the maximum deduction allowable, you must look to state law in the state where the employee is employed to determine the priority for payment. If the CCPA limits preclude 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 notify the child support agency using the Employer Response form.

Step 5: If enrollment cannot be completed until after a waiting period or other contingency, you must notify the Plan Administrator when the employee is eligible for enrollment.