Medical Support

Employer Responsibilities

The National Medical Support Notice (NMSN) packet arrives pre-populated with all the necessary forms and information to enroll the named child(ren). Once an employer receives the NMSN from Texas, or any other state, directing that health insurance coverage be provided for the child(ren) of an employee, the Order/Notice is binding on the current or subsequent employer regardless of the date of notice. A medical support order requiring that health insurance be provided for a child shall be considered a change in the employee's family circumstances for health insurance purposes, equivalent to the birth or adoption of a child. [TFC § 154.184(a)]

The employer must first determine (1) whether health care coverage is available and if so, (2) enroll the child(ren) in the appropriate plan.

Part A Employer Response – If items 1,2,3,4 or 5 below apply, complete and return the Employer Response (Part A) to the issuing agency within 20 business days of the date of the notice. If items 6 or 7 apply, return the Employer Response (Part A) to the issuing agency and forward the Plan Administrator Response (Part B) to the appropriate Plan Administrator, both within 20 business days of the date of the notice.

  1. The employee named in the notice has never been employed by the employer.
  2. We do not offer our employees the option of purchasing dependent or family health care coverage as a benefit of their employment.
  3. The employee is among a class (for example part-time or non-union employees) that is not eligible for family health coverage under any group health plan maintained by the employer or to which the employer contributes. Do not choose this selection if the employee is only temporarily ineligible for health care coverage. Proceed to Part B.
  4. Health care coverage is not available because the employee is no longer employed by the employer.
  5. State or federal withholding limitations and/or prioritization prevent withholding from the employee’s income amount required to obtain coverage under the terms of the plan.
  6. The participant is subject to a waiting period that expires more than 90 days from the date of the Notice, or the participant has not completed a waiting period, which is determined by some measure other than the passage of time, such as working a certain number of hours. At the completion of the waiting period, the Plan administrator will process the enrollment.
  7. Employer forwarded Part B to the Plan Administrator.

Part B – Plan Administrator Response – Complete and return to the issuing agency within 40 business days of the date of the notice when the employer can provide health care coverage. The employer must forward Part B to the Plan Administrator or benefits coordinator within 20 business days of the date of notice to allow the Plan Administrator time to do the following:

  • Determine if a waiting period or other contingency must be met before enrollment is complete OR
  • Enroll the child(ren) identified on the NMSN into a health insurance plan and complete the Employer Health Insurance Enrollment Form.
  • Complete and return Part B to the issuing agency.
  • Notify the payroll department of proper premium amount deductions.
  • Maintain the Health Insurance Status Change form for employment or lapses in insurance coverage.

Printable instructions to complete Part A and Part B of the NMSN are available in the NMSN packet or the Forms section of the Employer Website.

Other Source Health Insurance Information

Employees may provide a notice of prior health insurance enrollment of a child(ren) after receiving a National Medical Support Notice (NMSN) requiring the employee to provide employer sponsored health insurance coverage. Texas Family Code [TFC § 154.187(c)(1)] requires an employer to provide to the sender of the NMSN a statement that the child(ren) has been enrolled in the employer’s health insurance plan or is already enrolled in another health insurance plan in accordance with a previous child support or medical support order to which the employee is subject, e.g., a union insurance plan, dual employment, etc.

Employers may notify the Office of the Attorney General (OAG) that health insurance has been provided and is currently in effect for the child(ren) listed on the NMSN by printing and completing the Other Source Health Insurance Information form. This form must be mailed to the address listed within 40 days of receipt. When the information provided is verified, the OAG will inform the employer of any responsibility as it pertains to the NMSN.

Schedule of Benefits and Member Cards

Upon request, the employer shall furnish the following information to the Office of the Attorney General’s (OAG) Child Support Division (CSD): [TFC § 154.187 (e)]

  • Health insurance policy
  • Insurance membership cards
  • Schedule of benefits and any claim forms

Employers should mail the policy information and insurance cards to the OAG Medical Support Unit address located on the NMSN.

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