The National Medical Support Notice (NMSN)

The NMSN serves to inform employers that their employee has a court order to provide health care coverage to their dependents. The NMSN has the same effect as a court order.

If you have received a NMSN:

  • The court ordered your employee to provide health care coverage for dependents, if it is available.
  • The court ordered you to notify DOR if health care coverage for dependents is NOT available to your employee. See Part A.
  • The court ordered you to set up health care coverage for your employee's dependents, if it is available. See Part B.

The NMSN is comprised of:

Part A - The Employer Withholding Notice:

  • Part A is the form employers use to notify the issuing agency of any reason it cannot provide coverage according to the terms of the order.
  • If coverage for dependents is NOT available, employer must:

    1. Complete the form, and
    2. Return it within 20 business days from the date on the NMSN.

Part B - The Medical Support Notice to the Plan Administrator:

  • Part B is forwarded by the employer to its insurance plan administrator if the company can provide coverage.
  • Part B is the form the plan administrator uses to notify the issuing agency of the action that will be taken in accordance with the order.
  • If coverage for dependents IS available:

    1. Employer forwards NMSN to insurance plan administrator;
    2. Insurance plan administrator completes Part B (with effective date of coverage and name of health plan); and
    3. Insurance plan administrator returns Part B within 40 business days from the date of the NMSN.

Employer/Plan Administrator Responsibilities

  • Employers or health care providers who fail, without reasonable cause, to enroll a child in a health care plan, will be liable in a civil action, action for contempt, or other proceeding, for the full responsibility of medical costs incurred. (M.G.L. c. 119a § 12 (m).)

  • You must take all necessary actions to ensure that the children identified on the NMSN are enrolled in the employee's health care plan. No further notice or court order is necessary for you to comply. Children must be enrolled even if the employee declines insurance for himself or herself or refuses to enroll the children. Enrollment must be completed without regard to open season restrictions.

  • Health Insurance Portability and Accountability Act (HIPAA) restrictions have no impact on your obligation to report the information requested or to enroll the children in your health case insurance plan. HIPAA governs when protected health information may be released to third parties. (45 CFR Part 160 and Part 164, Subparts A and E.) The information requested in the NMSN is not protected health information. The information we request is not about the past, present, or future physical or mental health condition and does not relate to the provision or payment of health care.

  • Send all parts of the NMSN, including the brochure of instructions, if you need to forward the NMSN to another unit, to your insurance plan administrator, or to the union of the parent paying support.

  • Health insurance information, especially the insurance card for the children should be mailed directly to the parent receiving support at the address listed on the NMSN. You should forward this information to DOR only if no address is provided for the parent.

  • To ensure the privacy and personal safety of the parent and child involved, you must not disclose any personal data contained in the NMSN, such as the parent's address or the child's Social Security number, to your employee or any other person not authorized to receive such data.


  • You must enroll dependents even if the employee wants to refuse coverage or challenge the court.
  • You must enroll dependents even if it is not open enrollment season.
  • You must send health insurance cards and the enrollment information directly to the parent with custody of the children receiving the insurance.
  • You must not provide the parent receiving support's address or the child(ren's) Social Security number (or a copy of the NMSN) to the employee.
  • You face legal action and possible fines if you do not enroll an eligible dependent in health care coverage.

For more information or help regarding the NMSN:

  • You may view a copy of the National Medical Support Notice pdf format of National Medical Support Notice
, or review the Medical Support FAQs, for answers to commonly asked employer questions regarding this Notice, including information on withholding limits.
  • Call our NMSN customer service line at 866-330-6752. NOTE: This number is for questions regarding NMSN only.
  • Visit the website of the Federal Office of Child Support and select the bullet titled "FPLS/Employer Info."