National Medical Support Notice FAQs

The National Medical Support Notice (NMSN) is a federally-mandated standardized form that all state child support enforcement agencies are required to use. It is designed to assist employers who, in the past, received many different types of documents from states to enroll children of parents paying child support in employer health insurance plans. Find answers to some frequently asked questions below.

What if the employer does not offer health insurance to its employees?

The employer must check Box 2 on the "Employer Response" portion of Part A of the Notice and return Part A to the Department of Revenue (DOR) at the address shown on the National Medical Support Notice (Notice).

If the employer offers insurance, but the employee does not qualify, what should the employer do?

The employer must check Box 3 on the "Employer Response" portion of Part A of the Notice and return Part A to DOR at the address shown on the Notice. However, if the employee will be eligible for insurance at a future date, the employer must forward Part B of the Notice to the plan administrator so the plan administrator can check box 4 and provide the date of eligibility.

What if the employee is not eligible for health insurance until a 90-day probationary period is up?

The employer is required to enroll the dependents in health insurance as soon as the employee is eligible for coverage. If there is a probationary period for new employees, the employer must forward Part B of the Notice to the plan administrator so the plan administrator can check box 4 and provide the date of eligibility. Once the probationary period is over, the employer must ensure that the dependents are enrolled in the insurance and that the plan administrator submits an updated Part B of the Notice to DOR.

If the employee has been terminated, what should the employer do?

The employer must check Box 4 on the "Employer Response" portion of Part A of the Notice, provide the termination date (if available), and any address information on the employee and his/her new employer, then return it to DOR at the address shown on the Notice.

What should the employer do if the person named on the Notice has never worked for the employer?

The employer must check Box 1 on the "Employer Response" portion of Part A of the Notice and return to DOR at the address shown on the Notice.

What if the child is covered by MassHealth? Does the employee still have to provide insurance?

Yes. The court order mandates that the employee obtain private health insurance if it is available through the employer, even if the child already receives MassHealth (which is a public assistance benefit).

What if the employer doesn't respond to the Notice or enroll the child in a health insurance plan?

Employers who receive a Notice (which has the same effect as a court order), cannot deny health care coverage to an employee’s child. If an employer denies enrollment in a health care plan without reasonable cause, the employer could be liable in a civil action, action for contempt or other appropriate proceeding for the full amount of medical costs incurred and for attorneys' fees. The law can be found in section 12(m) of chapter 119A of the Massachusetts General Laws.

What should an employer do if the employee refuses family coverage or to enroll dependents?

The employee has been ordered by the court to provide health care coverage for his or her dependents and must abide by the terms of the court order. The employer is required by law to honor the Notice (which has the same effect as a court order), and must enroll the employee and his or her eligible family members even if the employee does not want to enroll or if the employee fails to sign or submit an application for enrollment. The law can be found in section 12(k) of chapter 119A of the Massachusetts General Laws.

What if the employee's child is already enrolled in another plan by the custodial parent?

The employee was ordered to provide health care coverage for his or her dependents and must abide by the terms of the court order. If either parent wants to change the terms of the order, he or she must go back to court to get the order modified.

Pursuant to the Notice, employers are legally obligated to enroll their employee’s dependents in the company-sponsored insurance unless DOR provides you with a letter indicating that you must stop action on the Notice. DOR can issue such a letter when it is provided with satisfactory written evidence that the dependent is enrolled in a comparable plan.

DOR has a process in place to assist employees whose dependents have private health insurance coverage through a source other than their employer. The employee can contact DOR at [phone] or [phone] to provide the proof of insurance coverage.

If however, a custodial parent contacts the employer directly and indicates that he or she has concerns about enforcement of the order and his or her safety or the safety of the dependents, please contact DOR at [phone] or [phone] and provide the name of the custodial parent and other information that would help us identify the case.

What if the employee claims that the dependents are not his/her children?

Any claim that the dependents are not the employee’s must be directed to the court that issued the order. The employer must enroll the employee and dependents in the family health insurance plan until notified by DOR or the court to do otherwise. If the employee has questions about his or her case, he or she can contact DOR at [phone] or [phone].

How much can the employer deduct for insurance?

DOR follows the federal Consumer Credit Protection Act (CCPA) limits (15 USCS § 1673(b)) for deductions of child and medical support. The CCPA limits the amount which can be deducted from an employee’s disposable earnings to 50% in the case of an employee who is supporting a second family in his or her household and 60% in the case of an employee without a second family. The limits are increased to 55% and 65% respectively if the employee owes arrears that are 12 weeks or more past due. Massachusetts law prioritizes withholding first for current cash support, then for health insurance premiums, then arrears.

Disposable earnings are the net income remaining after making mandatory deductions such as state, federal, local, Social Security and Medicare taxes.

When determining the insurance premium for the CCPA calculation, use the marginal cost, which is the difference between an individual and a family plan.

Note: Unless the child can be enrolled consistently in an insurance plan (without a break in coverage that results from nonpayment of the premium), then the child should not be enrolled. 

Additional information on CCPA limits can be obtained by calling DOR’s Employer Services Group at [phone] or [phone].

How long does the employer need to keep the dependent covered?

The dependent must be covered by private health insurance until the terms of the court order change or the order for insurance terminates.

What should the employer do if the employee has reconciled with the other parent or has remarried?

The employer must continue to provide health insurance coverage for the eligible dependents until advised to do otherwise by DOR or the court.

How much time does the employer have to enroll the dependents and return the Notice?

Within 20 business days from the date of the Notice, the employer must notify DOR of any reason it cannot provide coverage according to the terms of the order. If the employer is able to provide coverage, the employer must forward Part B of the Notice to its health insurance plan administrator, and the plan administrator then has 40 days from the date of the Notice to complete the “Plan Administrator Response” of Part B and return it to DOR.

Can an employer wait to cover the dependents until our enrollment season?

No. The employee’s court order for health insurance coverage overrides an "open enrollment" date, so the employer must enroll the dependents without regard to any restrictions on enrollment periods. The law can be found in section 12(l) of chapter 119A of the Massachusetts General Laws.

Should the employer return the enrollment packet to the other parent or to DOR?

If the Notice from DOR contains an address for the other parent, the employer must send the information to him or her at that address. If there is no address for the other parent, the employer must forward insurance information, including an ID card to DOR, at P.O. Box 55261, Boston, MA 02205-5261. We will forward the information to the other parent.

THE INFORMATION ON THE NATIONAL MEDICAL SUPPORT NOTICE IS CONFIDENTIAL AND EMPLOYERS ARE PROHIBITED FROM GIVING THE CUSTODIAL PARENT’S ADDRESS OR ANY OTHER PERSONAL DATA TO THE EMPLOYEE OR TO ANY OTHER PERSON NOT AUTHORIZED TO RECEIVE SUCH INFORMATION.

What happens if the employee's current spouse is covering the dependents under his or her policy?

The employee was ordered to provide health care coverage for his or her dependents and must abide by the terms of the court order. If either parent wants to change the terms of the order, he or she must go back to court to get the order modified.

Pursuant to the Notice, employers are legally obligated to enroll their employee’s dependents in the company-sponsored insurance unless DOR provides you with a letter indicating that you must stop action on the Notice. DOR will issue this letter when it is provided with satisfactory written evidence that the dependent is enrolled in a comparable plan.

DOR has a process in place to assist employees whose dependents have private health insurance coverage through a source other than their employer. The employee can contact DOR at [phone] or [phone] to provide the proof of insurance coverage.

If however, a custodial parent contacts the employer directly and indicates that he or she has concerns about enforcement of the order for insurance and his or her safety or the safety of the dependents, please contact DOR at [phone] or [phone] and provide the name of the custodial parent and other information that would help us identify the case.

If a union provides the employee's health care coverage, what should the employer do?

The employer must consider the union to be the Plan Administrator and forward Part B of the National Medical Support Notice to the union. Because Massachusetts General Laws also defines an 'employer' as any entity through which a labor organization provides health care coverage to its members (M.G.L. c. 119A, §1A); the Notice is applicable to the union.

What if the employee is on Workers' Compensation?

If the employee is still eligible for or currently enrolled in a health insurance plan, the employer must enroll the employee’s dependents in the plan. If the employee is not eligible for or enrolled in a plan, the employer must contact DOR’s Employer Services Unit at [phone] or [phone] to inform us that the employee is receiving Worker’s Compensation benefits.

Does the employer need to do anything if the employee is already covering the dependents?

If the dependents listed on the Notice are the same dependents covered by the employee’s insurance, the employer or the plan administrator must complete the insurance information on Part B of the Notice and return it to DOR. If any dependents listed on the Notice are not covered by the employee’s insurance, the employer must add them to the health insurance plan and then return the Notice to DOR.

Does the employer need a copy of the court order or the child's birth certificate?

No. The Notice meets all of the requirements of a Qualified Medical Child Support Order under ERISA. It has the same effect as a court order for the employee to provide health care coverage for the dependents identified on the Notice. M.G.L. Chap. 119A, §12.

If we offer more than one plan, in which plan should we enroll the employee's dependents?

If the employee already has health care coverage through the employer, then the employee’s dependents must be enrolled in that plan. If the employee does not select a plan, and there is a default plan, enroll the employee and the dependents in that plan. You must ensure that whatever plan the child is enrolled in will cover the child based on his or her place of residence.

If there is no default plan, send information on the available plans to DOR at P.O. Box 55261, Boston, MA 02205-5261 and we will confer with the custodial parent to help him or her choose an option. We will contact the employer with the information on the plan chosen so that they can enroll the dependents and complete and return the Notice to DOR.

What if the dependents aren't eligible for coverage because they live outside the coverage network?

If the only health insurance plan offered by the company is through an HMO or other managed care organization with a geographically limited benefit area and no reciprocity, you do not need to enroll the dependents in the insurance plan. In this case, return Part A of the Notice to DOR with Box 2 checked. However, if you offer other insurance plans that would cover the dependents, then the dependents must be enrolled in one of those plans, even if this means that the employee has to change insurance plans.

What date should I use as the effective date of enrollment in the insurance for the dependents?

Use the date that you received the Notice as the effective date of coverage. Since the Notice has the same effect as a court order, it overrides an "open enrollment" date, so the dependents must be enrolled without regard to any restrictions on enrollment periods.

Will responding to the Notice violate the Health Insurance Portability and Accountability Act?

HIPAA restrictions have no impact on your obligation to report the information requested on the Notice or to enroll the dependents in your health insurance coverage. This is because HIPAA permits the disclosure of this information to an entity carrying out its responsibility under federal and state law. DOR is requesting the information in furtherance of its mandate to enforce court-ordered health care coverage of dependents. 45 CFR Part 160 and Part 164, Subparts A and E; 42 U.S.C. § 666(a)(19); 45 CFR 303.32; M.G.L. c. 119A §12.