FAQs about court-ordered dependent enrollments

Medical Child Support Orders are issued by state authorities pursuant to domestic relations law, and provide for the monetary support or coverage of dependents under the employee's health plans.

A Qualified Medical Child Support Order (QMCSO) specifically sets forth the right of dependents to receive benefits under group health plans. However, it is the responsibility of the plan administrator to determine whether the Medical Child Support Order order is qualified, and if so, to provide coverage for the named dependents.

A National Medical Support Notice (NMSN) is a medical support order issued by state child support agencies. The notice is used by the agencies to enforce child support obligations, and requires dependent children to be covered under the health plan of the named parent. Employers receive these notices when an employee with an existing child support obligation is hired, or when the obligation is enforced. The NMSN document consists of two notices in Parts A and B, which set forth specific response deadlines.

Part A, Notice of Withhholding:

The employer must also confirm that the employee's plan contributions do not exceed the federal and state limitations on withholding. For additional detail on where to locate this information, please click here. If the employee's contributions would exceed the Federal or State withholding limitations once the child is enrolled, the employer must indicate accordingly in the Part A Employer Response and notify the issuing agency.

Part B Medical Support Notice to Plan Administrator

If the employee is no longer employed by the company or ineligible under the group health plan (e.g. due to part-time status), the company must provide this information in the Employer Response section of Part B, and return it to the issuing agency within 20 business days after the Notice Date. If the provisions of the NMSN apply to the employee, Part B must be transferred to the group health plan no later than 20 business days after the Notice Date.

If the plan administrator determines that the Notice is a QMSCO, under the requirements stated above, they must also complete the Plan Administrator Response in Part B, and return it to the issuing agency within 40 business days after the Notice Date.

Please click here for further information on the Notice Date for Court Order Enrollments.

The plan administrator must review the Medical Child Support Order (MCSO) document for the following information in order to make a qualification determination:

  • The name and last known address of the employee and dependent (the name and address of a state agency or official may be substituted for the address of the child).
  • The eligibility of the employee--employee need not be enrolled under the plan, but must be eligible to receive coverage, and must abide by the plan's waiting period where necessary.
  • A description of the type of health coverage required--an MCSO cannot require a company to provide coverage that is unavailable under its plan (e.g. vision coverage for the child, where the plan only offers medical and dental)
  • The duration of the order

Per the Department of Labor's guidance, the administrator has a "reasonable period of time" to make a qualification determination, inform the employee and dependents and initiate the coverage process.

However, if the order is a National Medical Support Notice, the administrator is required to abide by specific processing times, as set forth below and/or on the notice itself.

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