HR Hotline: What Does a National Medical Support Notice Require?

HR & Safety

Q: We just received a National Medical Support Notice, requiring us to enroll our employee’s daughter in our healthcare plan. However, the employee is not enrolled, and they are refusing to complete the election forms necessary to enroll them or their child.

How should we handle this? Are we allowed to deduct the cost of the premiums from their paycheck without their permission?

A: Yes, you are not only “allowed” to do this, but you are legally required to do so, unless the employee either has insufficient disposable income, or is not eligible to elect dependent coverage from your plan.

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Medical support is a form of child support. Connecticut provides for healthcare coverage in its child support guidelines, and the Office of Child Support Services (a division of the Department of Social Services) is statutorily required to pursue private healthcare coverage when it’s available through a parent’s employer at a reasonable cost.   

The National Medical Support Notice is a legal document used by a child support agency to enforce healthcare coverage support provisions in a child support order.

The NMSN notifies an employer that its employee has been ordered to provide healthcare coverage to a dependent. The NMSN serves as notice to the employer that:

  1. The employee is legally obligated to provide employment-based healthcare coverage for a child;
  2. The employer may be required to withhold any employee contributions required by the group health plan in which the child is eligible to be enrolled; and
  3. The employer is required to forward the NMSN to the plan administrator for enrollment determination purposes. 


Whether the healthcare coverage is available for a “reasonable cost” will depend on the employee’s income and whether the cost exceeds a specified percentage of that income. This information will be listed on the NMSN form itself.

If a parent must obtain coverage for themself in order to obtain coverage for the child, the “reasonable cost” is determined based on the combined cost of coverage.

The employee does not have the option to simply decline coverage; their refusal to complete election paperwork does not relieve the employer of its obligation to provide coverage to the child.

In some circumstances, enrollment will not be possible.

The employee’s refusal to complete election paperwork does not relieve the employer of its obligation to provide coverage to the child.

For example, where an employer does not offer dependent coverage, where an employee’s part-time status makes them ineligible for coverage, or where the cost is not “reasonable” based on their income level.

If this is the case, the employer completes Part A of the NMSN form and returns it to the issuing agency with no further obligation to enroll the employee in coverage.

Employers should note that they may be subject to sanctions or penalties for discharging an employee, refusing to employ an applicant, or taking disciplinary action against an employee because of an NMSN, or for failing to withhold income or failing to respond or comply with the notice.

You can find more information regarding an employer’s responsibility to respond to National Medical Support Notices from the U.S. Department of Health and Human Services website.

HR problems or issues? Email or call CBIA’s Diane Mokriski at the HR Hotline (860.244.1900) | @HRHotline. The HR Hotline is a free service for CBIA member companies.


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