National Medical Support Notice
5-step checklist for processing a
National Medical Support Notice

Step 1:

Upon receipt of a National Medical Support Notice (NMSN), the employer must determine whether any of the first three numbered circumstances on Part A, Employer Response applies to the employer or the employee.

Step 2:

If one of the first three numbered circumstances applies, the employer must complete the Employer Response form and return it to the child support enforcement agency within 20 business days. If none of the first three categories on the Employer Response applies to the employer or the employee, the employer will forward Part B - Medical Support Notice to Plan Administrator to the employer's plan administrator within 20 business days after the date of the NMSN.

Step 3: If the plan administrator informs the employer that enrollment cannot be completed until after a waiting period or other contingency (which expires more than 90 days from the date the plan administrator receives Part B), the employer must notify the plan administrator when the employee is eligible for enrollment.

Step 4:

The plan administrator will notify the employer when enrollment has been completed. The employer must then notify his/her payroll office or service to make the appropriate deductions for the employee contribution required under the health care plan. It is at this point that the employer determines whether or not the employee's total deductions exceed the maximum allowed under the federal Consumer Credit Protection Act (15 U.S.C., section 1673(b)) and/or the laws of the state of the employee's principal place of employment.

Step 5:

If the employer determines that the amount of child and/or spousal support, coupled with the deduction for health care plan premiums, exceeds the maximum deduction allowed, the employer must look to state law in the state of the employee's principal place of employment to determine the priority for payment. If the federal/state limits preclude payment of ongoing child and/or spousal support and health care plan premiums, and the priority scheme does not allow for the payment of the health care plan premium, the employer must notify the child support enforcement agency by completing No. 4 on the Employer Response form and sending the form to the agency. (See Frequently Asked Questions for more information.)