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Child Support Services
Illinois Child Support

National Medical Support Notice


A 1993 amendment to the Employee Retirement Income Security Act (ERISA) requires employer-sponsored group health plans to extend health care coverage to the children of a parent/employee who is divorced, separated, or never married when ordered to do so by state authorities.

The National Medical Support Notice (NMSN)

The federal government mandates that all states use a standardized form - the National Medical Support Notice (NMSN) - to notify an employer to withhold premiums from an employee's income when a parent is ordered to provide health care coverage for his or her child(ren). Illinois law (ILCS 5/10-16.2 allows for the use of both the universal Order/Notice - Income Withholding for Support and/or National Medical Support Notice.

The NMSN is the notice employers receive from the state child support enforcement agency instructing them to enroll a child(ren) in available dependent health coverage. The NMSN helps ensure children receive health care coverage when it is available and required as part of a child support order. It is designed to simplify the work of employers and plan administrators by providing uniform documents requesting health care coverage.

What the Employer Receives

The NMSN Packet Includes:

Part A - Employer Response Part

  • Notice to Withhold for Health Care Coverage
  • Employer Response
  • Instructions to the Employer

Part B - Plan Administrator Part

  • Medical Support Notice to the Plan Administrator
  • Plan Administrator Response
  • Instructions for the Plan Administrator
  • Health Insurance Report
The issuing agency may include the NMSN packet as part of the Order/Notice - Income Withholding for Support packet.

Definition of a Qualified Medical Child Support Order (QMCSO)

Upon receiving the NMSN packet, the employer determines if the state agency has correctly completed the notice and if it meets the requirements for a Qualified Medical Child Support Order (QMCSO) under ERISA. To be "qualified," a medical support order must clearly specify:
  • The participant's name and last-known address;
  • 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; and
  • The period for which the order applies.
If the NMSN lacks any of the required information, but that information is reasonably available to the employer, the employer should consider the NMSN qualified and proceed with enrolling the child(ren) in the medical plan. If the information is not available, the employer will return the NMSN to the issuing agency.

Note: All Illinois-issued NMSNs are pre-printed and contain all necessary information and should be considered qualified.

Employer NMSN Responsibilities

The employer must return the Part A response within 20 business days of receipt to the issuing agency if the employee's dependents cannot be enrolled for one of the following five accepted reasons:
  1. Employer does not provide insurance;
  2. Employee is not eligible for insurance;
  3. Employee is no longer employed with the employer;
  4. Deductions exceed withholding limits; or
  5. The employer has a mandatory waiting period prior to enrollment.
If medical coverage is available through the employer, the employer is required to forward Part B to the employer's plan administrator no later than 20 business days after the date of the notice.

The plan administrator has 40 business days from the date of the notice to complete Part B, including the specific medical coverage information and the Health Insurance Report and return it to the issuing agency.

The plan administrator should also contact the employer so payroll can start deducting premiums from the employee's pay, if applicable.

If the cost to enroll the dependent(s) exceeds the limits allowable under the Consumer Credit Protection Act (CCPA), the employer will complete #4 on the employer response form and forward it to the issuing agency.

Note: The Employer and Income Withholding Page provides the CCPA guidelines under Income Withholding and the CCPA.

Coverage Requirements

Medical support is a form of child support often provided as health care insurance under a parent's work-related health care coverage. However, medical support can take several forms. The non-custodial parent may be ordered to:
  • Provide health insurance, if available, through his/her employer;
  • Pay for private health insurance (health care coverage) premiums or reimburse the custodial parent for all or a portion of the costs of health insurance obtained by the custodial parent; or
  • Pay additional amounts to cover a portion of ongoing medical bills or as reimbursement for uninsured medical costs.
If neither parent has health care insurance, the child support order may provide for a specific dollar amount to be deducted for medical expenses.

Current law requires that every child support order, enforced by a state Child Support Enforcement (CSE) agency, include a provision for health care coverage. States are required to include provisions for health care coverage in their child support guidelines, and the CSE agency is required to pursue private health care coverage when such coverage is available at a reasonable cost.

State laws require that health care coverage be provided under a medical support order even if the child:

  • Was born out of wedlock;
  • Is not claimed as a dependent for tax purposes; or
  • Does not reside with the parent or in the insurer's service area.

Penalties for Noncompliance

The employer is required to transfer Part B of the National Medical Support Notice to the plan administrator or appropriate group health plan providing insurance coverage for which the child is eligible within 20 business days after the date of the notice. If the employer does not transfer Part B within the required timeframe, the employer may be liable for the full amount of medical expenses incurred by or on behalf of the child and which would have been paid or reimbursed by the health insurance coverage.