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HHS Issues Updated National Medical Support Notice and Instructions


· 5 minute read


· 5 minute read

National Medical Support Notice Forms and Instructions (Jan. 19, 2023); HHS Action Transmittal AT-23-01 (Jan. 17, 2023)

Forms and Instructions

Action Transmittal

HHS’s Office of Child Support Enforcement has released an updated version of the National Medical Support Notice (NMSN) with changes to both Parts A and B. An NMSN is a standardized medical child support order that is used by state child support enforcement agencies to obtain group health coverage for children. NMSNs consist of two parts. Part A (Notice to Withhold for Health Care Coverage) notifies an employer that an employee is legally obligated to provide medical coverage for the child (or children) identified in the notice and instructs the employer to withhold any employee contributions required by the group health plan in which the child is enrolled. Part B (Medical Support Notice to Plan Administrator) is to be forwarded by the employer to its plan administrator if the child is eligible for enrollment in a group health plan (or completed by the employer if the employer serves as plan administrator). A properly completed NMSN—which may be transmitted electronically in certain states (see our Checkpoint article)—is considered a Qualified Medical Child Support Order (QMCSO) for ERISA purposes.

Among other changes, the revised forms now include a sample Part A, standalone instructions, and a new addendum to Part B to be completed by the plan administrator. The addendum is used to provide information about the medical, dental, vision, prescription drug, mental health, or other coverage in which a child is enrolled, and to list any children who are at or above the age at which dependents are no longer eligible for coverage under the plan.

EBIA Comment: States have until November 1, 2023, to implement the revised NMSNs, so employers may not see the new forms until then. HHS has also provided Medical Support—FAQs with answers to employers’ common questions and a Medical Support Matrix that provides state-by-state information about medical support requirements. For more information, see EBIA’s Group Health Plan Mandates manual at Sections V.A (“What Are QMCSOs and Who Must Comply?”) and V.H (“National Medical Support Notices (NMSNs)”).

Contributing Editors: EBIA Staff.

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