By: HUB’s EB Compliance Team

The Department of Health and Human Services released an updated version of the National Medical Support Notice (NMSN) on January 19, 2023. State child support agencies will send a NMSN form to employers ordering them to provide health insurance coverage for the child(ren) of an employee that is divorced, separated, or otherwise so ordered. States have until November 1, 2023, to implement the new NMSNs. Employers will start to receive updated NMSNs between now and then.

A Brief Review of the NMSN and QMCSO Rules

An appropriately completed NMSN is considered a Qualified Medical Child Support Order (QMCSO) and must be honored by all employers’ group health plans governed by the Employee Retirement Income Security Act (ERISA). A QMCSO can also be established in a standard order if all the required elements are present, including:

  • the name and last known mailing address of the participant (employee) and each alternate recipient (child(ren));
  • a reasonable description of the type of health coverage to be provided (medical, dental, vision, or all health coverages); and
  • the period to which the order applies.

Employers that maintain an ERISA group health plan must review any order that they receive, whether NMSN or QMCSO, to determine if the order is qualified. Employers must then provide the coverage identified in the order, subject to certain limitations (e.g., if the order specifies cost limits that are lower than the cost of coverage, or if the employee in question is not otherwise eligible for the coverage being ordered).

What Changed on the New NMSN

The existing NMSN contains two parts, Part A and Part B. Both parts include the basic demographic detail needed to review and process the order, including the names of the participant and alternate recipient(s), all applicable contact information, and detail on the coverage that must be provided. Part A also includes a Response page that the employer uses to reply to the state agency. Part B is directed at the Plan Administrator and informs them that the alternate recipient (the child(ren)) is eligible for the coverage. The Plan Administrator then completes and returns the Part B Response page, or if the employer is also the Plan Administrator, then the employer completes this page as well.

In the new version of the NMSN, there are 4 new items: 1) a sample Part A Response page is now included, 2) a separate page of instructions on how to complete Part A, field by field, is now included, 3) a new Addendum is added to the Response page for Part B that includes detail on the coverage being provided, like insurance carrier names and related contact information, and 4) all parts now include space for up to 8 children, which previously was only for 6 children.

What Should Employers Do

Most employers have a benefits administrator or other HR-related platform to review and process all QMCSOs and NMSNs received by the employer. For employers that do not receive enough orders to warrant an outside vendor’s assistance, employers must respond to these notices when received. Therefore, keeping this updated information on-hand is likely to prepare you to properly respond to any orders that may be received in the future.

If you have any additional questions, please contact your HUB Advisor. You may also view more compliance articles in our Compliance Directory.

NOTICE OF DISCLAIMER

Neither Hub International Limited nor any of its affiliated companies is a law or accounting firm, and therefore they cannot provide legal or tax advice. The information herein is provided for general information only and is not intended to constitute legal or tax advice as to an organization’s or individual's specific circumstances. It is based on Hub International's understanding of the law as it exists on the date of this publication. Subsequent developments may result in this information becoming outdated or incorrect and Hub International does not have an obligation to update this information. You should consult an attorney, accountant, or other legal or tax professional regarding the application of the general information provided here to your organization’s specific situation in light of your or your organization’s particular needs.