Plan Administrator

National Medical Support Notice

Questions & Answers

I am confused about the language in the instructions, which says, "All enrollments are to be made without regard to open season restrictions." However, the Plan Administrator Response refers to "waiting period" both in #2 and #4, and indicates that the enrollment may be processed at the completion of the waiting period. Is enrollment subject to a waiting period or not?
Federal and state law require that if a court orders an individual to provide family coverage for child(ren), that the employer and health insurer must enroll the child "without regard to any enrollment period restrictions that may apply under the policy." Many health plans have open enrollment ("open season") periods. For instance, new enrollment for the coming year may be limited to October of the previous year. Employers and Plan Administrators must enroll the child immediately, and may not wait until the next "open enrollment season" (i.e. October).

However, the employer may have a general policy that an employee is ineligible for family health coverage until the employee has worked for the employer for a specific period, such as 3 or 6 months, or 1000 hours. This is the permissible "waiting period" described in the Plan Administrator Response.

The disenrollment criteria does not include the failure to pay the premiums. If premiums are not received for the insurance, must the plan provider still provide coverage?
State law §767.513(4)(c) states that "After the child has coverage under the employer’s health benefit plan, and as long as the parent is eligible for family coverage under the employer’s health benefit plan, continue to provide coverage for the child unless the employer receives satisfactory written evidence that the court order is no longer in effect or that the child has coverage of health care expenses under another health insurance policy or health benefit plan that provides comparable coverage of health care expenses."

State law §632.897(10)(am)3 states, "After the child is covered under the group policy or individual policy, and as long as the individual is eligible for family coverage under the policy, continue to provide coverage for the child unless the insurer receives satisfactory written evidence that the court order is no longer in effect or that the child has coverage under another group policy or individual policy that provides comparable health care coverage."

The disenrollment criteria states disenrollment can occur if "the employer eliminates family health coverage for all its employees." What if family coverage is eliminated for some employee classifications, and the employee with the medical insurance order is in one of the classifications that no longer is eligible for family coverage?
If the employee classification of your employee with the medical insurance order is no longer eligible for family coverage, you should treat that employee as you do others in the same classification. You should also notify the Issuing Agency (listed in upper-left corner of the National Medical Support Notice) that the employee is no longer eligible for family coverage.

State law §767.513(4)(c) states that "After the child has coverage under the employer's health benefit plan, and as long as the parent is eligible for family coverage under the employer's health benefit plan, continue to provide coverage for the child unless the employer receives satisfactory written evidence that the court order is no longer in effect or that the child has coverage of health care expenses under another health insurance policy or health benefit plan that provides comparable coverage of health care expenses."

State law §632.897(10)(am)3 states, "After the child is covered under the group policy or individual policy, and as long as the individual is eligible for family coverage under the policy, continue to provide coverage for the child unless the insurer receives satisfactory written evidence that the court order is no longer in effect or that the child has coverage under another group policy or individual policy that provides comparable health care coverage." What constitutes satisfactory written evidence?
Satisfactory written evidence means the employer is notified in one of three ways.

  1. The employer receives, for the employee, a new Order/Notice to Withhold Income for Child Support with the Health Insurance Box not filled in. By not checking this box the child support agency is indicating that the employee is not court ordered to provide health insurance coverage for his/her dependent children.

  2. The employer receives a letter from the child support agency stating that the identified employee's medical support order has been officially ended and or the employee is no longer obligated to provided health insurance coverage through his/her employer.

  3. A parent provides written documentation from an insurance carrier that the child has comparable health insurance coverage, and that coverage is currently in effect. You or the employer must notify the Issuing Agency (listed in upper-left corner of the National Medical Support Notice) prior to ending coverage for the child.

Does the plan administrator have to send separate notification of coverage to the custodial parent and the child(ren)?
If the custodial parent and the children have the same address listed on the National Medical Support Notice, the plan administrator may send a single notice to that address. In most cases, if the custodial parent and the children have the same address, the children's address will not be listed on the National Medical Support Notice.

In some cases, the other parent's and the children's address will be the same as the address for the Issuing Agency. In these cases, coverage information should be sent to the Agency address.

In some cases, a name and address of a Representative of the children will be listed. Coverage information should be sent to that address.

I am a self-insured employer. Our company is subject to ERISA, and requires a Qualified Medical Support Court Order (QMSCO) before a dependent is added to an employee's health plan. Can I still require a QMSCO or must I accept the National Medical Support Notice?
The Department of Labor and the Department of Health and Social Services jointly developed the National Medical Support Notice and published the requirements in the Federal Register. The final regulation can be viewed at http://www.dol.gov/ebsa/regs/fedreg/final/2000032411.pdf.

The Department of Labor issued the National Medical Support Notice under section 466(a)(19) of the Social Security Act, section 609(a)(5)(C) of the Employee Retirement Income Security Act of 1974 (ERISA), and for State and local government and church plans, section 401(e) and (f) of the Child Support Performance and Incentive Act of 1998.

The National Medical Support Notice meets the requirements for a Qualified Medical Support Court Order. The plan administrator of a group health plan must treat the Notice as a Qualified Medical Support Court Order under section 609(a) of Title I of the Employee Retirement Income Security Act (ERISA).

If you determine that a specific Notice does not constitute a (perhaps there is some missing required information for that particular notice), you must complete Response 5 of Part B - Plan Administrator and send it to the Issuing Agency, and inform the noncustodial parent, custodial parent and children of the specific reasons for your determination

Contact for Additional Questions

If you have any questions regarding the Notice, you may contact the Issuing Agency at the address and telephone number listed in the National Medical Support Notice (on the upper left-hand corner).

More Information

More information about the National Medical Support Notice is available on the Internet at:

Return to Orders for Medical Support & Health Insurance


Updated May 27, 2010

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