Table of Contents
1. What about health insurance?
Many child support orders require the employer to enroll
the employee’s children in the company‘s health insurance program, with the
employee to pay his or her share of the costs. When health insurance is
required in the child support order, child support agencies will send out a
National Medical Support Notice also known as an NMSN.
2. What is the National Medical Support Notice?
The National Medical Support Notice (NMSN) is a two-part
notice sent to employers from the child support agency. Its purpose is to
ensure that children receive health care coverage, when it’s available and
required as part of a child support order, and to simplify the work required of
employers and Health Plan Administrators (HPA’s) by providing standardized
forms nationwide by all child support agencies, for health care coverage.
3. When is the NMSN sent to Employers?
The NMSN is sent in conjunction with a wage withholding
order. Once an employer is matched to a non-custodial parent’s case, a
wage withholding order and NMSN will be generated to the employer. The
NMSN is also sent when a new child support order is issued that does not address
child support but requires the non-custodial parent to provide health care
coverage (AKA Medical Support Only).
4. Are employers and Health Plan Administrators
(HPA) required to comply?
Yes. Federal law requires all employers and HPA’s
to make health care coverage available to children of non-custodial parents who
are eligible and qualified for such coverage. The NMSN forms were developed for
5. What is included in the NMSN?
Part A of the NMSN
includes a Notice to Withhold for Health Care Coverage (Health Care Notice),
the Employer’s Response form, and Instructions.
Part B includes a
Medical Support Notice to the Plan Administrator, the Plan Administrator’s
Response form, and Instructions. A worksheet is also included.
6. When is the worksheet needed?
The worksheet must be completed when an employee has been determined to be eligible for
health care coverage, and qualified to participate in the program. This
worksheet helps the employer determine if the amount to be withheld falls
within the maximum amount allowed under Alaska law or the Consumer Credit
Protection Act (CCPA). The worksheet must be completed and returned to CSSD.
7. What must the employer do once the children are
The employer will determine whether the combined cost of
health care coverage, child support and spousal support is within the limits on
withholding (A worksheet is provided for this purpose). If the amount is within
the legal limits, the employer will begin withholding the contribution from the
employee’s wages. If the combined amount exceeds the limit, the employer
will complete Section 4 of Part A and return Part A and the completed worksheet
8. Who completes Part A of the NMSN?
The employer completes Part A, indicating
whether the non-custodial parent is eligible for dependent health care
coverage. If the employer determines the employee is eligible, the
employer retains Part A and forwards Part B to the Health Plan Administrator.
9. Who completes Part B of the NMSN?
The Health Plan Administrator (HPA) completes
Part B. If the HPA
determines the employee is not qualified to participate, the HPA will return
the completed Part B to the employer who in turn returns the form to the child
If the employee is qualified, the HPA will enroll the
children, return the completed Part B to the employer and the child support
agency, and sends forms and health care coverage information to the custodial
10. How soon must both parts of the Notice be completed?
Within 20 business days of the date of the NMSN.
The employer must complete Part A of the form and either
forward Part B to the Health Plan Administrator or return Part A to the child
Within 40 business days of the date of the NMSN
1.the HPA must complete
and return Part B to the employer and to the child support agency; and
2.the employer must
complete the worksheet and either begin withholding or, if the amount exceeds
the limits, return Part A and the worksheet to the child support agency.
11. I have a withholding order and there is a box
saying “if checked medical withholding is necessary”. The box isn’t checked but
I received a separate medical withholding notice. Which do I comply with?
The employer should respond to all National Medical
Support Notices received.
12. What if the employee doesn’t want to enroll the
child for medical coverage?
The employee does not have a choice. The National Medical
Support Notice is a qualified medical support order. If health insurance
is available, the employer is required to enroll the child or children as
instructed by the notice. However, the employer must adhere to
limitations imposed on withholding as mandated by Alaska law and the
CCPA. If the employee objects, they must contact CSSD or complete the
bottom portion of the, “Notice of Enforcement of Health Care Withholding” which
was sent directly to the employee. This will allow the employee an
opportunity to object to withholding. However, the employer must still
comply with the NMSN regardless of whether an Administrative Review has been
13. When must health care coverage withholding start?
The Notice for Health Care Coverage requires withholding
for the cost of health care as soon as certain determinations about eligibility
14. What if the children are already covered under
another outside plan, a current spouse, or have benefits through Indian Health
The employer has an obligation to comply with the
National Medical Support Notice until a notice terminating the medical
withholding is received. However, we want to avoid having an employee charged
for insurance if alternate coverage is being provided. Before we can
issue a termination to our NMSN the employee must provide CSSD with the
children are covered and the effective date of coverage
name, address and phone number
·Policy number and any
required identification numbers
·Names of all
·Confirmation from the
employer or insurer of the total cost of coverage for policy holder, spouse,
children and other dependents to include the employee only rates, as well as
the cost to add additional family members to the policy
15. What if the child is covered under Denali Kid Care?
Denali Kid Care, or any Medicaid related program, is not
considered a substitute for medical insurance. The employer must still comply
with the medical withholding order.
16. The employee doesn’t make enough to cover the regular
child support amount and medical coverage premiums. What do we do?
The employer should check box 4 of the Employer Response
(Part A), complete the calculation sheet, and return both to CSSD. We will then
determine the next action for medical enforcement.
17. The employee and dependents are eligible for
coverage. However, our coverage is limited to within the state and the child
lives out-of-state. What do we need to do?
Notify CSSD in writing, indicating coverage is available
but only within a limited area.
18. When will health care coverage withholding stop?
The withholding order for Health Care Coverage remains in
effect until you are notified by the child support agency of any changes.
However, if we terminate the withholding order for Health Care Coverage, the
non-custodial parent may still elect to continue health care coverage.
19. What if the employee terminates?
You must notify the child support agency promptly when
the employee leaves and give the employee’s last known home address and – if
you know it – the new employer’s name and address.
Alaska law requires you to keep record of the Notice of
WAGE Withholding for three years and to enforce the Notice if the employee
returns to the job within that period of time. It is advisable to keep
the NMSN in conjunction with the wage withholding order.
20. When are payments for health care coverage due?
The Health Care Notice requires you apply withheld wages
to the cost of health care coverage according to your company’s usual policy.
21. What if I get more than one Health Care Notice for the same employee?
Determining the best way to handle multiple orders can be
If you have specific questions in regards to the NMSN,
you may contact our Medical Enforcement section directly at (907) 269-6858.
you have questions regarding regular wage withholding, you can contact us at
our Employer Hotline number – (907) 269-6089 or toll-free in Alaska (877)
269-6685, or you can fax questions to (907) 787-3197. You can also refer
to our website at
22. Can I fire the employee so I don’t have to bother with offering health
No. You could be fined up to $1000.00 if you refuse
to hire an applicant or if you discipline or fire an employee because of a
Heath Care Notice. You could also be ordered to pay court costs.
23. Is the employee entitled to a credit against their child support obligation
for providing Health Insurance to the child/ren?
If the employee is providing health care coverage for the
child/ren through the employer, spouse’s employer or private insurance we may
be able to credit up to 50% of that cost to the monthly child support. If
the support order allows for credit. If the support order authorizes a
different percentage or credit amount, we will use that amount. Before CSSD can
determine the credit, CSSD must verify that coverage is in place and the cost
is for the children’s coverage. If the employee is requesting credit, they must
send CSSD a confirmation notice (or letter) from the insurance provider or
The notice must include:
24. Who can I call?
To collect and disburse child support payments.
We strive to ensure children receive their support through cooperation and collaboration using innovation to drive our success with the communities, partners, and families we serve.
Alaska Department of Revenue
CHILD SUPPORT SERVICES DIVISION
550 W 7th Ave, Suite 310
Anchorage AK 99501-6699Phone: 907-269-6900Fax: 907-787-3220
American with Disabilities Act (ADA) Accommodation Requests:
If you require an accommodation to access our services due to a disability, please contact our Anchorage Office.