Alaska Child Support Services Division

Frequently Asked Questions for Employers
about the National Medical Support Notice

Table of Contents

  1. What about health insurance?
  2. What is the National Medical Support Notice (NMSN)?
  3. When is the NMSN sent to Employers?
  4. Are employers and Health Plan Administrators (HPA) required to comply?
  5. What is included in the NMSN?
  6. When is the worksheet needed?
  7. What must the employer do once the children are enrolled?
  8. Who completes Part A of the NMSN?
  9. Who completes Part B of the NMSN?
  10. How soon must both parts of the Notice be completed?
  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?
  12. What if the employee doesn’t want to enroll the child for medical coverage?
  13. When must health care coverage withholding start?
  14. What if the children are already covered under another outside plan, a current spouse, or have benefits through Indian Health Services?
  15. What if the child is covered under Denali Kid Care?
  16. The employee doesn’t make enough to cover the regular child support amount and medical coverage premiums. What do we do?
  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?
  18. When will health care coverage withholding stop?
  19. What if the employee terminates?
  20. When are payments for health care coverage due?
  21. What if I get more than one Health Care Notice for the same employee?
  22. Can I fire the employee so I don’t have to bother with offering health care coverage?
  23. Is the employee entitled to a credit against their child support obligation for providing Health Insurance to the child/ren?
  24. Who can I call?


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 this purpose.


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 enrolled?

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 to CSSD.


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 support agency.

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 parent.


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 support agency.

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 requested.


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 are made.


14. What if the children are already covered under another outside plan, a current spouse, or have benefits through Indian Health Services?

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 following documentation:

  • Confirmation the children are covered and the effective date of coverage
  • Insurance provider’s name, address and phone number
  • Policy number and any required identification numbers
  • Names of all persons covered
  • 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 pretty complicated. If you have specific questions in regards to the NMSN, you may contact our Medical Enforcement section directly at (907) 269-6858. If 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 http://www.childsupport.alaska.gov/Employers/Employer_Information.asp


22. Can I fire the employee so I don’t have to bother with offering health care coverage?

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 employer. 

The notice must include:

  • Confirmation the children are covered and the effective date of coverage
  • Insurance provider’s name, address and phone number
  • Policy number and any required identification numbers
  • Names of all persons covered
  • 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

24.Who can I call?

Call CSSD’s Employer Hotline at 269-6089