Child Support Enforcement (CSE)
Employers: National Medical Support Notice
Per federal and state laws, state child support enforcement programs (CSEs) issue a two-part form, the National Medical Support Notice (NMSN), when an employee is ordered to provide employment-related health insurance coverage. Federal and state laws require the use of a standard NMSN form. An NMSN is often sent in conjunction with an income withholding order.
Upon receipt of the NMSN, the employer must determine whether the employee has dependent or family health insurance coverage available through the employer's plan. If such coverage is not available to the employee, the employer must send Part A (Notice to Withhold for Health Care Coverage) of the NMSN to the issuing CSE indicating the reason health insurance is not available. If such coverage is available to the employee, the employer must send Part B (Medical Support Notice to Plan Administrator) of the NMSN to the insurer within 20 business days.
After receiving Part B of the NMSN from the employer, the insurer must send Part B to the issuing CSE within 40 business days indicating the action that has been, or will be, taken. Upon enrollment of the child, the insurer must notify the employer of the enrollment. The employer must then determine whether necessary employee contributions are available to complete the enrollment. If enrollment cannot be completed, the employer must send Part A of the NMSN to the issuing CSE indicating that state or federal withholding limitations or prioritization prevent the withholding from the employee's income of the amount required to obtain health insurance coverage. If enrollment can be completed, the employer must withhold any necessary employee contribution and transfer the withheld income directly to the insurer.
When the employee's principal place of employment is North Dakota, the employer must withhold any amounts owed under an income withholding order prior to withholding any amount for health insurance premiums.
When the employee's principal place of employment is North Dakota, the total amount the employer may withhold for amounts owed under an income withholding order and health insurance premiums cannot exceed 50% of the employee's disposable income.
The NMSN remains in effect until the employer is notified by the issuing CSE of any changes. If the issuing CSE terminates the NMSN, the employee may elect to continue health insurance coverage. Please consult with the employee before terminating coverage as this termination notice does not affect the employee's request for individual coverage or coverage for these children, other children, or other family members.