Home Default: Washington State Division of Child Support
Washington State Department of Social and Health Services Home page

Division of Child Support

Medical Support Notice Information

If you have questions about the National Medical Support Notice, you can get help in the following ways:

Medical Support FAQ


[FAQs are separated into categories, some questions appear in more than one category. Each question is a link to the answer at the end of the list of questions.]

Responding to the Notice

Enrollment

Premiums/Withholding Limits

Plan Administrators/Unions

Multiple State Involvement


Medical Support FAQs


How can I respond to the Notice?


  • Respond to Part A, Notice to Withhold for Health Care Coverage by returning the Employer Response or by calling DCS.
  • If you serve as your own plan administrator, respond to Part B, Medical Support Notice to Plan Administrator by completing the Plan Administrator Response and the Washington State Addendum to Box 2 of Part B - Plan Administrator Response and returning both to DCS.

How long do I have to respond to the Notice?

  • Within 20 business days after the date of the Notice:
    • Check the appropriate box and send the Employer Response to DCS, or call DCS with the appropriate response.
    • Send Part B, Medical Support Notice to Plan Administrator to the office or labor union who administers the health care plan.
  • If you serve as your own plan administrator, return the Plan Administrator Response to DCS within 40 business days after the date of the Notice.

We do not offer insurance to our employees. What do I do?

  • If insurance IS available through a union, send Part B to the union's third party administrator.
  • If insurance IS NOT available through a union, check box 2 on the Employer Response form and send the response to DCS.

Our employees have insurance through a union. How do I notify DCS of the union coverage?

Send Part B Medical Support Notice to Plan Administrator (including the Cover Letter and Washington State Addendum to Box 2) to the union's third party administrator. Check box 7 on the Employer Response form, enter the date Part B was sent, and send the Employer Response to DCS.

We do our own insurance enrollments. We do not have a plan administrator. How do I respond to DCS?

If you offer insurance for which the children are eligible, enroll the children, and complete the Washington State Addendum to Box2 of Plan Administrator Response form and the Plan Administrator response form. Return both forms to DCS within 40 business days after the date of the Notice.

What could happen if we fail to comply with the NMSN?

Under Washington State law, an employer who fails or refuses to comply with the Notice can be fined up to $1,000 per occurrence.

Should we notify DCS when the employee is providing insurance for the children and leaves our employ?

Yes. The employer must promptly notify DCS when the employee is no longer employed.

We cannot enroll the children because the employee is not enrolled. Do we have to enroll the employee?

YES. As long as the cost of the children's premium does not exceed the limit in the Notice and the current child support amount plus the cost of the premium for the employee and children does not exceed 50% of the employee's net disposable income.

If we have to enroll both the employee and the children, does the premium limit shown on the Notice include the amount the employee has to pay for themselves and the children?

NO. The premium limit shown on the Notice applies only to the additional cost the employee has to pay for the children's coverage.

EXAMPLE: If the cost for the employee only coverage is $33 per month and the cost for the employee plus children is $85 per month then the cost for the children only is $52 per month. ($85 -$33 =$52). If the premium limit on the notice is $52 or more, you would have to enroll both the employee and the children.

When the employee works in Washington State, the most we can withhold for child support from the employee's net disposable earnings is 50%. How does the health insurance premium figure into the 50% limit?

Assuming the cost of the children's premium does not exceed the limit shown on the Notice, the answer depends on whether or not the employer has to enroll just the children or enroll both the employee and the children.

When the employer has to enroll only the children, the cost of the children's premium plus the cash support amount cannot exceed the 50% limit. For example: The employee is already enrolled and paying a premium of $28. The additional cost to enroll the children is $46. The employer should enroll the children if the cash support amount plus the children's premium cost ($46) does not exceed 50% of the employee's net disposable income.

When the employer has to enroll both the employee and children, the cost of both the employee's and children's premium plus the cash support amount cannot exceed the 50% limit. For example: The employee is not enrolled. The cost to enroll the employee is $20.50. The additional cost to enroll the children is $39.50. The total for both is $60. The employer should enroll the employee and children if the cash support amount plus the employee's and children's premium cost ($60) does not exceed 50% of the employee's net disposable income.

When the children or the employee and children cannot be enrolled because the premium plus the cash support amount exceeds the 50% limit, check box 5 on the Employer Response form and send the form to DCS. DCS may call you when you mark box 5. To avoid a call, you are welcome to note on the form that the cash support plus the premium would exceed the 50% withholding limit. If the plan administrator has already added the children to the plan, contact the plan administrator to tell them the children cannot be added.

The employee and dependents are eligible for coverage. However, our coverage is limited to a specific service area and the child lives out-of-state or the child lives in a different part of the state outside of the plan's service area. What should we do?

The employee is required to provide insurance coverage that is accessible to the child. Under the Revised Code of Washington and the Washington Administrative Code, "Accessible coverage" means health insurance coverage which provides primary care services to the children with reasonable effort by the custodian.

Do not enroll the child if the coverage is not accessible to the child. Notify DCS that the child cannot be enrolled and tell DCS why.

We offer multiple insurance plans. How do we determine in which plan to enroll the children?

  • When the employee is already enrolled, enroll the children in the same plan as the employee.
  • When the employee is not enrolled and there are multiple plans within the premium limit shown on the Notice that would cover the children, DCS will select the plan. Provide DCS the following information about each plan: description of the coverage, additional cost the employee would have to pay to cover the children and whether there is a limited service area for the plan.

The employee is enrolled in a local HMO plan that will provide only emergency coverage to the child. There is a Preferred Provider Plan available that has medical providers where the child lives. Should we change the employee to the Preferred Provider Plan?

DCS does not require that the employee be moved to another plan because DCS has no way of knowing if the employee has a spouse and/or other children already covered on his/her current plan. Some plan administrators will make the employee change plans to one that will cover the child where the child lives when the employee is the only one on the plan. However, this decision is up to the individual plan administrator.

What if the employee objects to enrolling the children or withholding income to pay for the coverage?

The employee may contest the withholding under the Notice, based on a mistake of fact, by contacting DCS. The employer must continue to withhold the premiums until notified by DCS to discontinue withholding.

What if the employee tells the employer the children are already covered under a private pay plan, a current spouse, or have benefits through Indian Health Services?

The employer has an obligation to comply with the Notice until they receive a Release terminating the medical withholding. The employee should contact DCS immediately and provide proof of coverage.

I received 2 (or more) NMSN's for one employee. How do I determine the employee's premium limit for the children?

Refer to "Cover Letter for the National Medical Support Notice - Part A-", Section #2:

  • Shows how much the employee has to pay for the children on that Notice.
  • Add the amount on each Notice together to get a total. This is the most the employee has to pay to cover only the children listed on the Notices.
  • If one NMSN has a set amount and another has no limit, the total is "no limit".
  • If the cost to enroll the children is more than the total premium limit, mark box 5 on the Employer Response and tell DCS the cost of the children's premium. (Example: Premium cost is $ ________.)

If we have to enroll both the employee and the children, does the premium limit shown on the Notice include the amount the employee has to pay for him/herself and the children?

NO. The premium limit shown on the Notice applies only to the additional cost the employee has to pay for the children's coverage.

EXAMPLE: If the cost for the employee only coverage is $33 per month and the cost for the employee plus children is $85 per month then the cost for the children only is $52 per month. ($85 -$33 =$52). If the premium limit on the notice is $52 or more, you would have to enroll both the employee and the children.

What do I do if the cost of the children's coverage exceeds the premium amount shown on the Notice?

Check box 5 on the Employer Response form and send the form to DCS and indicate the cost the employee would have to pay for the dependent coverage.

What is the priority of withholding in Washington State?

When the employee's principal place of employment is Washington State, the priority of withholding is current support first, the health insurance premium second, and past-due support last. When the employee's principal place of employment is not Washington State, the employer will have to contact the child support agency in that state for priority information.

Who is the plan administrator?

The plan administrator is the person designated to enroll employees and their dependents in insurance plans. Employers can:

  • Contract with a private company to handle enrollments
  • Have a benefits office within their company that handles enrollments. OR
  • Handle the enrollments themselves.

When the employees have health insurance benefits through a union, the union's third party administrator is the plan administrator. The third party administrator generally handles premium Payments
 
.

When I send Part B to the plan administrator, what do I send back to DCS?

Check box 7 on the Employer Response form, enter the date Part B was sent, and send the Employer Response to DCS.

How will I know if the plan administrator enrolls the children?

After the children are enrolled, the plan administrator will notify you to withhold the premium from the employee's earnings.

What information should the plan administrator or the employer give to DCS when the children are enrolled?

The plan administrator or employer may complete the Washington State Addendum to Box 2 of Part B - Plan Administrator Response or provide any preprinted information that provides the insurance information. DCS needs the insurance company name, address, telephone number, and the employee's policy or member number, and group number. For federal audit purposes, DCS must have the employee's insurance information in the DCS case files.