Income Withholding for Dependent Health Insurance (Medical Support)

Not your employee?
If the employee or independent contractor named on a National Medical Support Notice does not work for you, complete Item 1 or Item 4 and the Contact for Questions section of Part A (EMPLOYER RESPONSE) and return Part A to the Issuing Agency as soon as possible.

Employers help more than 170,000 children each year by withholding health insurance premiums from noncustodial parents' earnings.

When a noncustodial parent is ordered to provide health insurance for dependent children, the employer will receive a National Medical Support Notice (NMSN) (PDF). The NMSN consists of two parts. Part A must be completed by the employer. Part B must be completed by the Plan Administrator, which may be the employer or another organization, such as a labor union.

An employer must respond to the NMSN within 20 business days after the date of the Notice.

If you need a copy of the NMSN, call the Child Support Helpline at 1-888-208-4485 (TTY: 1-866-875-9975), Monday–Friday, 8:00 AM–7:00 PM. A copy will be mailed to you in 5–7 business days.

When you receive a National Medical Support Notice (NMSN)

Even if health care coverage is not available to the employee or independent contractor through your organization, complete the appropriate steps to respond to the NMSN:

  1. Verify the identifying information in Part A, Page 1
  2. Within 20 business days after the date of the Notice:
    Return Part A—if coverage is not available
    —or—
    Send Part B to the Plan Administrator
  3. Withhold the health insurance premium
  4. Notify the Issuing Agency of employee termination

Verify the identifying information in Part A, Page 1

When you receive the NMSN, you should immediately read the NOTICE TO WITHHOLD FOR HEALTH CARE COVERAGE (Part A, Page 1). Verify all the information, especially the Issuing Agency, the Notice date, the court information, your organization's name and address, and the employee or independent contractor's information.

If you have any questions about any of this information, contact the Issuing Agency immediately.

If the person named is not your employee, continue to Part A (EMPLOYER RESPONSE), complete Item 1 or Item 4 and the "Contact for Questions" section, and return Part A to the Issuing Agency.

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Return Part A—if coverage is not available

Review the numbered items in Part A, EMPLOYER RESPONSE. Items 1 through 4 describe circumstances when health care coverage is not available for the employee.

If any of the first four items applies, mark the appropriate box, complete the "Contact for Questions" section at the bottom, and return Part A to the Issuing Agency within 20 business days after the date of the Notice. Keep a copy for your records, but you do not need to do anything else.

Part A Employer Response ITEMS If YES… Otherwise…
1. Employee has never been employed by this employer Check Box 1, complete "Contact for Questions" section, and return Part A to the Issuing Agency. Forward Part B to Plan Administrator as soon as possible.

You must send it within 20 business days after the date of the Notice.
2. Employer does not provide dependent or family coverage Check Box 2, complete "Contact for Questions" section, and return Part A to the Issuing Agency.
3. Employee is permanently ineligible for coverage Check Box 3, complete "Contact for Questions" section, and return Part A to the Issuing Agency.

Do NOT check this item if the employee will become eligible.
4. Employee is no longer employed by this employer Check Box 4, provide information about termination and new employer (if known and applicable), complete "Contact for Questions" section, and return Part A to the Issuing Agency.

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Send Part B to the Plan Administrator

If your organization offers health insurance coverage and the employee or independent contractor is or will become eligible, send Part B of the NMSN (4 pages) to the Plan Administrator as soon as possible. You must send it within 20 business days after the date of the Notice.

The Plan Administrator must complete Part B and return it to the Issuing Agency within 40 business days after the date of the Notice. If you are also the Plan Administrator for your company, then you must complete Part B and return it to the Issuing Agency within 40 business days.

Otherwise, wait for notification from the Plan Administrator. If you do not receive a timely response, contact the Plan Administrator to be sure Part B has been completed and returned to the Issuing Agency.

A response to Part B of the NMSN is required within 40 business days after the date of the Notice.

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Withhold the health insurance premium

When you are notified by the Plan Administrator that the children have been enrolled in health care coverage, you should begin withholding any employee contributions to the group health plan, as required and allowed by law, including the limitations on withholding required by the Consumer Credit Protection Act (CCPA).

Waiting period

The Plan Administrator may notify you that the employee or independent contractor is subject to a waiting period that expires more than 90 days from the date the Plan Administrator received the NMSN or a waiting period that depends on another requirement, such as number of hours worked. If you receive notification of a waiting period, complete and return Part A (Item 6 of the EMPLOYER RESPONSE) to notify the Issuing Agency of the enrollment timeframe. Notify the Plan Administrator again when the employee is eligible to enroll.

Calculate withholding limitations

Use the Withholding Limitations Worksheet (PDF) or the online calculator to help you determine whether you can withhold the health insurance premium. The Withholding Limitations Worksheet page and the Cases with Prorated Amounts page explain in detail how to determine when you can withhold the health insurance premium.

The full amount of the health insurance premium must be withheld; the premium cannot be prorated or paid in part. Withholding the health insurance premium depends on the answers to these questions:

  1. Is the total of all obligations—current, past-due, and other amounts plus the health insurance premiumless than the Maximum Withholding for the employee or independent contractor?
    If yes, withhold the health insurance premium and the full amount of all obligations.
  2. Is the total of all the current support obligations—plus the health insurance premiumless than the Maximum Withholding?
    If yes, withhold the premium, the current obligation amounts, and any remaining amount up to the Maximum Withholding (see an example).

Unless you can answer "yes" to one of these questions, you cannot withhold the health insurance premium.

Be sure to remit the amount of the premium to the appropriate health care plan.

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Notify the Issuing Agency if enrollment cannot be completed

If the employee or independent contractor's earnings do not allow the full health insurance premium to be withheld, complete Part A (Item 5 of the EMPLOYER RESPONSE) and the "Contact for Questions" section at the bottom of the page and return Part A to the Issuing Agency as soon as possible. Keep a copy for your records, but you do not need to do anything else. You will receive a termination notice from the Issuing Agency.

Notify the Issuing Agency of employee termination

When the employee or independent contractor leaves your employ for any reason, complete Part A (Item 4 of the EMPLOYER RESPONSE) and the "Contact for Questions" section at the bottom of the page. Return Part A to the Issuing Agency as soon as possible. You will receive a termination notice from the Issuing Agency.