Medical Support

Frequently Asked Questions

Does an employer have the capability to report medical support or dental support online?
Yes. All employer responsibilities regarding child support can be handled online at
Top of page
In what health insurance coverage is an employer required to enroll the child(ren)?
An employer is required to enroll children in insurance plans as indicated on the NMSN. When ordered to enroll in a Medical Insurance plan, an employer should enroll the child(ren) in a basic health care services plan that offers physician services, office visits, hospitalization, laboratory services, X–rays, and emergency services.

When ordered to enroll in a Dental Insurance plan, an employer should enroll the child(ren) in a basic dental services plan that offers diagnostic, preventative, and basic services.

Top of page
What if an employer does not have any record of an employee listed in the National Medical Support Notice (NMSN)?
The employer can indicate the employee has never been employed with the employer by completing Part A: Employer Response and checking box #1.
Top of page
What if an employer does not offer insurance to employees?
If insurance is not offered to employees, complete the Employer Response (Part A) form and select box #2. If the employer is a registered user of the Employer Website and has elected to receive NMSNs electronically, the Employer certifies that medical insurance coverage is not offered to any of its employees and is required to enter a date not greater than 6 months for review on the online application. It is understood that the employer can renew this online NMSN Part A response, indicating we do not offer insurance to any employee, by updating the effective end date every six months. If insurance becomes available, the employer is required to update the Employer Profile and uncheck the box that reads “We do not offer insurance” and make sure to mark the box on the system to receive NMSNs electronically.
Top of page
If the paper NMSN is completed and mailed or faxed, should the forms also be completed online?
No. The purpose of the online application is to make the process of responding and enrolling dependents in health insurance easier for employers. If the employer chooses to use the online application, then the paper NMSNs do not need to be completed and the employer must update their Employer Profile to receive NMSNs electronically.
Top of page
What if an employee has a waiting period for health insurance enrollment?
If you are the employer, fill out box 6 on Part A and return it to the Issuing Agency. Then forward Part B to the Plan Administrator.

If you are the Plan Administrator, depending on the terms of the waiting period, complete either box 2D or box 4 on the Plan Administrator Response - Part B.

Top of page
What if an employer receives the NMSN, but the employee claims health insurance coverage is being provided from another source?
If the employer is made aware the employee has the child(ren) enrolled in another health insurance plan in accordance with a previous child support or medical support order then the employer should notify our agency within 40 days of receiving the NMSN by printing and completing the Other Source Health Insurance Information form.

In addition, the employee should contact his/her local child support office or call the Child Support Call Center at (800) 252-8014 to discuss whether a modification is appropriate.

Top of page
What if the employee refuses to sign insurance enrollment forms to enroll the dependent in the employer sponsored insurance plan?
The employer should proceed with the enrollment, even if the employee will not sign enrollment forms. The employee is entitled to a contest based on "mistake of fact" and must follow the contest procedures found in the Texas Administrative Code, at
Top of page
What if an employer has medical support or dental support related questions?
Employers may contact the Medical Support Unit at (800) 522-2421 or may contact the Employer Call Center at (800) 850-6442.
Top of page
Do employers have to complete both the Employer Response (Part A) and the Plan Administrator Response (Part B)?
It depends. If the employer selected response 1 through 5 on Part A, then nothing else is required.

If the employer selected response 6 or 7, then the employer should forward Part B to the Plan Administrator. The Plan Administrator will need to submit Plan B response to the Issuing Agency once the enrollment in health insurance has occurred.

Top of page
When should an employer terminate health insurance coverage? Is there a specific end date?
Unless the court order states otherwise, the health insurance and child support obligation normally ends when the child turns 18 or graduates from high school, whichever occurs later. The OAG will notify the employer when the employee is no longer required by court order to provide health insurance coverage for the child(ren). However, the notice does not inform the employer/employee to terminate health insurance but merely indicates health insurance coverage may be canceled upon authorization of the employee.
Top of page
If an employee goes on workmen’s compensation, what does the employer do with the health insurance if the employee cannot continue to provide health insurance?
If the employee is no longer eligible for the employer sponsored health insurance plan, the coverage would be terminated. The employer should notify the OAG within 15 days of insurance interruption by completing the Health Insurance Status Change Form.
Top of page
What is the proper way for the employer to issue health insurance cards and other medical related documents when the employer does not have the other parent’s address??
Whenever the employer does not have the other parent’s address, the employer should send the health insurance cards and any other necessary policy information to the OAG Medical Support Unit address provided on the NMSN.
Top of page
What does “reasonable cost” mean?
Reasonable cost is a factor used by the court when ordering a parent to provide health insurance for a child or children. Reasonable cost is not a factor that should be considered by the employer when enrolling children. Even if an employer or employee believes the cost is not reasonable, the employer must follow the order and enroll the children. The employee should be directed to raise reasonable cost concerns with a Child Support Division caseworker or by seeking a modification of the court order.
Top of page
What if the employee tells the employer the children are on the CHIP or Medicaid program?
The NMSN prevails and is binding on the employer. The child(ren) must be enrolled in the employer’s sponsored health insurance plan as indicated on the NMSN. Medicaid and CHIP are state funded health care plans. In most cases, neither is acceptable to fulfill a court ordered obligation for health insurance coverage.
Top of page
Can the employer charge a processing fee to the employee for complying with the NMSN?
Top of page
What if the employee doesn’t earn enough money to cover the health insurance premiums and child support?
In the State of Texas, health care insurance premiums are a pre-tax deduction and are deducted from an employee’s gross earnings. The federal law protecting 50% of the “net” pay does not apply to health care insurance premiums.

Example: The employee earns $400 a week before deductions. In Texas, it is mandatory to deduct taxes, union dues, and health insurance premiums before determining what is available to be the “net” or take-home pay. If taxes for this employee equal $60 per week and the health insurance premiums are $75 a week, the employee is left with $265 as net pay in which only $132.50 could be remitted for child support from the employee’s disposable earnings that week. If the employee’s child support is less than that amount, then the employee will be able to fully meet his/her obligation through withholding. If the employee’s child support obligation is greater than that amount, the employee is responsible for paying the remainder of the obligation in order to keep from accruing child support arrears.

Top of page
How should we consider the employee’s cost of health insurance when computing disposable earnings for purposes of applying the withholding limit which in Texas is 50% of disposable earnings?
Texas Family Code section 101.010 provides "'Disposable earnings' means the part of the earnings of an individual remaining after the deduction from those earnings of any amount required by law to be withheld, union dues, nondiscretionary retirement contributions, and medical, hospitalization, and disability insurance coverage for the obligor and the obligor’s children." When the employer provides health insurance coverage, the employee’s health insurance premiums actually paid by the employee for the employee’s coverage should be considered when computing disposable earnings. If the employee also covers children, then the employee’s health insurance premiums actually paid by the employee for covering the children should be considered.
 If...   Then...
Employee covers only the employee Deduct the cost when computing disposable earnings
Employee covers the employee and any children Deduct the cost when computing disposable earnings
Employee covers the "employee and spouse" or "employee and family" Deduct the cost when computing disposable earnings
Employee covers only a spouse (not the employee and not any children) DO NOT deduct the cost when computing disposable earnings

Unfortunately, if the insurances costs result in reaching the withholding limit, then the employer will not be able to assist the employee by withholding and remitting full amount of child support obligations on the employee’s behalf. Any child support payments, child support arrearage payments, medical support payments or medical support arrearage payments that remain unsatisfied due to the withholding limit must be paid by the employee through other means.

Top of page
What if an employer receives a NMSN without a dependent’s Social Security number (SSn)?
Since a dependent’s SSn is not required information to be included in a Qualified Medical Support order, an employer may not refuse to comply with a NMSN based upon the absence of a dependent’s SSn.
Top of page
This employee is only a part-time employee and not eligible for insurance. What do we do?
Check the box #3 on the Employer Response page of the NMSN Part A form that says, “The employee is among a class of employees that are not eligible for family health coverage under any group health plan maintained by the employer or to which the employer contributes.”
Top of page
The employee is disputing the issuance of the NMSN, what can we do?
The employee may contact their local child support office and request an administrative review. The employer must proceed with the enrollment process until notice of termination is received.
Top of page
Why are you sending me multiple forms for the same employee?
Each NMSN form is for a particular child support case and the child(ren) on that case. If an employee has multiple cases, you may receive multiple notices.
Top of page
What if an employer receives the NMSN with an order to provide medical and dental insurance, however the employer offers either medical or dental, but not both? How should the forms be completed?
If the employer offers either medical or dental insurance, the employer should complete the Plan Administrator Response (Part B) indicating which insurance they offer and complete the enrollment form. The employer should also indicate on the enrollment form which insurance is not available to their employees.
Top of page