Hawaii Employer’s Guide to Medical Support

An Employer’s Guide to Medical Support

Recent changes to the Social Security Act have had an impact on medical support and the employer’s responsibility. The law now requires employers to honor the federally standardized National Medical Support Notice (NMSN).

The Child Support Enforcement Agency (CSEA) will issue the NMSN for cases receiving full services through CSEA in which the non-custodial parent has been ordered to provide health care coverage and coverage is available through a non-custodial parent’s (NCP) employer at a reasonable cost. The NMSN is comprised of four parts with instructions:

  1. Part A – Notice to Withhold for Health Care Coverage
    Part A will be completed by the child support agency and will provide identifying information to the employer about the case and the employee. It informs the employer of the type of coverage required under the order.
  2. Employer Response
    The NMSN should first be directed to Human Resources or personnel. The Employer Response should be completed and returned to issuing agency when:

      • Employer does not provide health care coverage;
      • Employee is ineligible for health coverage due to work status; or
      • Employee has been terminated.
      • State or Federal withholding limitations and/or prioritization prevent the withholding from the employee’s income of the amount required to obtain coverage under the terms of the plan.
  3. Part B – Medical Support Notice to Plan Administrator
    If the employer can provide coverage, Part B is forwarded to Plan Administrator who has 40 business days from the date of the notice to complete the response and return it to the CSEA.
  4. Plan Administrator Response
    The Plan Administrator must:
      • Enroll children in health care plan;
      • Notify issuing agency of the action that will be taken in accordance with the order;
      • Send information if options exist; and
      • Notify the employer so that payroll can make proper deductions.

Step-By-Step: When you receive the NMSN:

Step 1: Once you receive the NMSN, determine whether any of the four categories on Employer Response apply to you or this employee. You may only be able to determine whether one of the first three apply at this stage.

Step 2: If so, complete the Employer Response form and return it to CSEA within 20 business days. If none of the four categories on the Employer Response apply to you or this employee, forward Part B to your plan administrator.

Step 3: The plan administrator will notify you when enrollment has been completed. You must then notify your payroll department to make the appropriate deductions for employee contributions required under the health plan. It is at this point that you may determine that the total deductions exceed the maximum allowed under the CCPA, and any applicable state law.

Step 4: If, in fact, you determine that the amount of support coupled with the deduction for health care premiums exceeds the maximum deduction allowable, you must look to state law in the state where the employee is employed to determine the priority for payment. If the CCPA limits preclude payment of ongoing support and health care premiums and the priority scheme does not allow for the payment of the health care premium first, you must notify CSEA by completing No. 4 on the Employer Response form and send the form to the agency.

Step 5: If enrollment cannot be completed until after a waiting period or other contingency, you must notify the plan administrator when the employee is eligible for enrollment.

Employers and health insurance providers need to know that:

    • The NMSN complies with section 609(a)(3) and (4) of ERISA which pertains to informational requirements and restrictions against requiring new types or forms of benefits.
    • An appropriately completed NMSN is considered a “Qualified Medical Child Support Order” (QMCSO) and as such must be honored by all employer group health plans.
    • Enrollment of a child may not be denied on the ground that: (1) the child was born out of wedlock; (2) the child is not claimed as a dependent on the participant’s Federal income tax return; (3) the child does not reside with the participant or in the plan’s service area; or (4) because the child is receiving benefits or is eligible to receive benefits under the State Medicaid plan.
    • If the plan requires that the participant be enrolled in order for the children to be enrolled, and the participant is not currently enrolled, you must enroll both the participant and the children.
    • All enrollments are to be made without regard to open season restrictions.
    • The employee may not eliminate coverage of the children unless the plan administrator is provided satisfactory written evidence that either: (1) the court or administrative child support order is no longer in effect, or (2) the children will be enrolled in a comparable health insurance plan elsewhere.

If you have any questions regarding the National Medical Support Notice, you may contact the Child Support Enforcement Agency through the Customer Service lines.