Thursday, December 1, 2022

National Medical Support Notice Requires Timely Response

I received a National Medical Support Notice for one of my employees. What is this notice and how do I respond?

A National Medical Support Notice (NMSN) is a notice sent to an employer from a local child support agency when an employee’s child is required, by a child support order, to be provided health care. It consists of two parts:

• Part A, which is completed by the employer; and

• Part B, which is completed by the plan administrator for the employer’s group health care plan.

An NMSN may come from a child support agency in California or in another state.

Timely Response

All employers who receive an NMSN must timely respond to the notice. If the person identified in the notice has never been your employee or is not a current employee, or if you don’t offer health care or if the employee is not eligible for health care benefits, you must indicate that on Part A of the NMSN and return it to the local child support agency that issued the NMSN within 20 business days from the date of the NMSN.

If the person identified in the NMSN is an employee who is eligible for your group health care plan, you must indicate that on Part A of the NMSN and return it to the local child support agency within 20 business days. You also must send Part B of the NMSN to your plan administrator, with instructions that the plan administrator enroll the employee’s child in your group health care plan.

The plan administrator has 40 business days to enroll the employee’s child, and complete and return Part B of the NMSN to the local child support agency. Once the child is enrolled, the plan administrator must send information about the health care coverage to the local child support agency.

Mandatory Enrollment

An NMSN is a qualified medical child support order, which means that when an NMSN orders a child to be enrolled in your group health care plan, enrollment is mandatory. If the employee objects to the child being enrolled, you still must proceed with enrollment; it is up to the employee to contest the order with the local child support agency.

If your group health care plan requires that the employee be enrolled in order for the employee’s child to be enrolled, you must enroll both the employee and the child to comply with the NMSN, even if the employee had previously declined coverage. You must enroll the employee and child within the time specified by the NMSN; you cannot wait until the next open enrollment period.

Both federal and state law require employers to comply with NMSNs. An employer who fails to comply with an NMSN can be found in contempt of court and face penalties and fines. In addition, employers must not discriminate or retaliate against an employee because of the existence of an NMSN.

More Information

Employers with questions about how to complete and comply with an NMSN can find more information from the California Department of Child Support Services at

Column based on questions asked by callers on the Labor Law Helpline, a service to California Chamber of Commerce preferred and executive members. For expert explanations of labor laws and Cal/OSHA regulations, not legal counsel for specific situations, call (800) 348-2262 or submit your question at

Staff Contact: Erika Pickles

Erika Pickles
Erika Pickles
Erika Pickles joined the CalChamber in 2015 as an HR adviser/employment law counsel. She previously represented employers in California and federal employment law litigation, class actions, and private arbitration involving a range of workplace-related issues, including wage and hour, discrimination, harassment, retaliation and wrongful termination claims. She also investigated and responded to administrative claims before state and federal agencies, and conducted employment law training seminars. She holds a J.D. from the University of San Francisco School of Law.

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