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Division of Child SupportFrequently Asked Questions...

Medical Child Support

Starting March 22, 2004, DCS will be using a new form to enforce medical support obligations. This form is called the National Medical Support Notice, or NMSN, and must be used by all child support agencies.

If you have questions about the National Medical Support Notice, you can get help in one or more of the following ways:

Why did DCS stop using the Notice of Enrollment and start using the National Medical Support Notice?

Because many employers receive withholding notices and medical enrollment notices from more than one state, the federal government decided a standard medical enrollment notice would be less confusing for employers. Most employers require a Qualified Medical Child Support Order (QMCSO) before they will enroll dependent children in their parent's health insurance plan. When properly completed, the National Medical Support Notice (NMSN) will be deemed a QMCSO. Federal regulations require child support agencies in all 50 states to use the NMSN. Since the NMSN is a federal form, states cannot make changes to it.

How long do I have to respond to the Notice?

Within 20 business days after the date of the Notice, you must either complete the Employer Response and send it to DCS or send Part B Medical Support Notice to Plan Administrator to the plan administrator.

Who is the plan administrator?

The plan administrator is the person designated to enroll the employees and their dependents. The employer may contract with a private company to handle enrollments; the employer may have a benefits office within their company that handles enrollments; or the employer may handle the enrollments themselves. When the employee has health insurance benefits available through a union, the union’s third party administrator is the plan administrator. The third party administrator is generally where the employer sends the premium payments.

When I send Part B to the plan administrator, what do I send back to DCS?

You do not have to send anything back to DCS when you forward Part B to the plan administrator. The plan administrator should respond to DCS.

How will I know if the plan administrator enrolls the children?

After the children are enrolled, the plan administrator will notify you to withhold the premium from the employee's earnings.

What information should the plan administrator or the employer give to DCS when the children are enrolled?

The plan administrator or employer may complete the Addendum to Box 2 of Plan Administrator Response or provide any preprinted information that provides the name, address, telephone numbers, policy numbers, and group numbers for claims submission. For federal audit purposes, DCS must have the employee's insurance information in the DCS case files.

We do not offer insurance to our employees. What do I do?

It depends on whether the employee has insurance available through a union. If insurance is not available through a union, check box 1 on the Employer Response form and send the Response to DCS. If insurance is available through a union, send Part B to the union's third party administrator.

Our employees have insurance through a union. The previous Notice provided a place for us to give DCS the union local and third party administrator information. The NMSN does not have a place for this information. How do I notify DCS of the union coverage?

You no longer have to notify DCS when insurance coverage is through a union. Send Part B Medical Support Notice to Plan Administrator (including the Cover Letter and Washington State Addendum to Box 2) to the union's third party administrator. The plan administrator should respond to DCS.

We do our own insurance enrollments. We do not have a plan administrator. How do I respond to DCS?

If you offer insurance for which the children are eligible, enroll the children, complete the Washington State Addendum to Box 2 of Plan Administrator Response form and the Plan Administrator Response form, and send both of these to DCS. You must send both forms to DCS within 40 business days after the date of the Notice.

I received 2 (or more) NMSNs for one employee. How do I determine the employee's premium limit for the children?

The Part A Cover Letter, under #5, b., should indicate how much the employee has to pay for the children on that Notice. Add the amount on each Notice together to get a total. This is the most the employee has to pay to cover only the children listed on the Notices. [Note: If one NMSN has a set amount and another NMSN has no limit, the total is "no limit".]

We cannot enroll the children because the employee is not enrolled. Do we have to enroll the employee?

Yes, in most cases. As long as the cost of the children's premium does not exceed the limit in the Notice, and the current child support amount plus the cost of the premium for the employee and children does not exceed 50% of the employee's net disposable income, you must enroll the employee. The instructions to the plan administrator (Part B) state that, "If the plan requires that the participant (employee) be enrolled in order for the child(ren) to be enrolled, and the participant is not currently enrolled, you must enroll both the participant and the child(ren)."

If we have to enroll both the employee and the children, does the premium limit shown on the Notice include the amount the employee has to pay for him/herself and the children?

No. The premium limit shown on the Notice applies only to the additional cost the employee has to pay for the children's coverage. For example: If the cost for employee only coverage is $33 per month and the cost for employee plus children is $85 per month, then the cost for only the children's coverage is $52 per month ($85 less $33 = $52). If the premium limit on the Notice is $52 or more, you would have to enroll both the employee and children.

What do I do if the cost of the children's coverage exceeds the premium amount shown on the Notice?

The premium amount shown on the Notice applies only to the additional cost for the children. It does not include the amount the employee would have to pay for "employee only" coverage. When the children's coverage costs more than the amount shown on Part A of the Notice, check box 4 on the Employer Response form and send the form to DCS. DCS may call you when you mark box 4. To avoid a call, you are welcome to note the children's premium amount on the Employer Response. If the plan administrator has already added the children to the plan, contact the plan administrator to tell them the children cannot be added.

When the employee works in Washington State, the most we can withhold for child support from the employee's net disposable earnings is 50%. How does the health insurance premium figure into the 50% limit?

Assuming the cost of the children's premium does not exceed the limit shown on the Notice, the answer depends on whether the employer has to enroll just the children (because the employee is already enrolled), or enroll both the employee and children.

When the employer has to enroll only the children, the cost of the children's premium plus the cash support amount cannot exceed the 50% limit. For example: The employee is already enrolled and paying a premium of $28. The additional cost to enroll the children is $46. The employer should enroll the children if the cash support amount plus the children's premium cost ($46) does not exceed 50% of the employee's net disposable income.

When the employer has to enroll both the employee and children, the cost of both the employee's and children's premium plus the cash support amount cannot exceed the 50% limit. For example: The employee is not enrolled. The cost to enroll the employee is $20.50. The additional cost to enroll the children is $39.50. The total for both is $60. The employer should enroll the employee and children if the cash support amount plus the employee's and children's premium cost ($60) does not exceed 50% of the employee's net disposable income.

When the children or the employee and children cannot be enrolled because the premium plus the cash support amount exceeds the 50% limit, check box 4 on the Employer Response form and send the form to DCS. DCS may call you when you mark box 4. To avoid a call, you are welcome to note on the form that the cash support plus the premium would exceed the 50% withholding limit. If the plan administrator has already added the children to the plan, contact the plan administrator to tell them the children cannot be added.

The employee and dependents are eligible for coverage. However, our coverage is limited to a specific service area and the child lives out-of-state or the child lives in a different part of the state outside of the plan's service area. What should we do?

If the plan will provide a minimum of urgent and emergent care that the child could use where the child lives, then the child should be added to the plan. If the plan does not provide a minimum of urgent and emergent care that the child could use where the child lives, then the child should not be added to the plan. Notify DCS in writing if the child cannot be added to the plan.

We offer multiple insurance plans. How do we determine in which plan to enroll the children?

When the employee is already enrolled, enroll the children in the same plan as the employee.

When the employee is not enrolled and there are multiple plans, within the premium limit shown on the Notice, that would cover the children, DCS will select the plan. Provide DCS with the following information about each plan: a description of the coverage, the additional cost the employee would have to pay to cover the children, and whether there is a limited service area for the plan.

The employee is enrolled in a local HMO plan that will provide only emergency coverage to the child. There is Preferred Provider Plan available that has medical providers where the child lives. Should we change the employee to the Preferred Provider Plan?

The child should be enrolled in the employee's plan as long as the plan will provide at least urgent and emergent care. DCS does not require that the employee be moved to another plan because DCS has no way of knowing if the employee has a spouse and/or other children already covered on his/her current plan. Some plan administrators will make the employee change plans to one that will cover the child where the child lives when the employee is the only one on the plan. However, this decision is up to the individual plan administrator.

What is the priority of withholding in Washington State?

When the employee's principal place of employment is Washington State, the priority of withholding is current support first, the health insurance premium second, and past-due support last. When the employee's principal place of employment is not Washington State, the employer will have to contact the child support agency in that state for priority information.

What if the employee objects to enrolling the children or withholding income to pay for the coverage?

The employee may contest the withholding under the Notice, based on a mistake of fact, by contacting DCS. The employer must continue to withhold the premiums until notified by DCS to discontinue withholding.

What if the employee tells the employer the children are already covered under a private pay plan, a current spouse, or have benefits through Indian Health Services?

The employer has an obligation to comply with the Notice until they receive a Release terminating the medical withholding. The employee should contact DCS immediately and provide proof of coverage.

What could happen if we fail to comply with the NMSN?

Under Washington State law, an employer who fails or refuses to comply with the Notice can be fined up to $1,000 per occurrence.

Should we notify DCS when the employee is providing insurance for the children and leaves our employ?

Yes. The employer must promptly notify DCS when the employee is no longer employed.