National Medical Support Notice (NMSN)

Requirements

The National Medical Support Notice (NMSN) is a two-part form issued to employers when an employee is ordered to provide health insurance for his or her children. The form is often sent along with an income withholding order.

• Part A – Employer
• Part B – Insurer/health plan administrator

Upon receipt of the NMSN, the employer must determine if the employee has dependent or family health insurance available.

• Health insurance not available – complete Part A (Notice to Withhold for Health Care Coverage) of the NMSN and return it to the issuing Child Support office.
• Heath insurance is available – send Part B (Medical Support Notice to Plan Administrator) of the NMSN to the insurer within 20 business days.
  • Insurer:
    • Complete Part B within 40 business days and return it to the issuing Child Support office.
    • Notify employer of the enrollment.
  • Employer:
    • Withhold the employee contribution and transfer the amount to the insurer.
    • Send Part A of the NMSN to the issuing Child Support office if enrollment cannot be completed because of withholding limitations or prioritization.
      • Limitations – when the employee's principal place of employment is in 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.
      • Prioritization – when the employee’s principal place of employment is in North Dakota, the employer must withhold any amounts owed under an income withholding order prior to withholding any amount for health insurance premiums.  The majority of states follow the same prioritization.  If the employee's principal place of employment is in a state other than North Dakota, please contact that state's Child Support Division.
    • Continue to withhold until notified by Child Support of any changes or termination of withholding.  Please consult with the employee before terminating coverage as Child Support terminating coverage does not affect the employee’s request for independent, dependent, or family health insurance.

Report Terminations

Employers must notify Child Support of the temporary layoff or termination of an employee when:

• Support is being withheld based on an income withholding order.
• Health insurance is provided in response to the National Medical Support Notice.

The notification must be within 7 business days of the layoff or termination. For more information on reporting terminations, visit the Layoffs and Terminations page.