MEDICAL SUPPORT

CS 493P Employer/Plan Administrator Responsibility - NMSN

01/23/03 Revised 07/06/18 Training Completed 07/20/18

45 CFR 303.32; U.C.A. 31A-8-502, 31A-22-610.5, 62A-11-326.2; R527-201

 

 

Employer Responsibility National Medical Support Notice (NMSN)

 

State law found at U.C.A. 62A-11-326.2 and R527-201 states that when an employer receives a National Medical Support Notice (NMSN), it must determine if the non-custodial parent/custodial parent (NCP/CP) is an employee, if family health coverage is available to employees, and if the employee (NCP/CP) is currently enrolled in an employment offered insurance plan.

 

62A-11-326.2.   Compliance with order -- Enrollment of dependent child for insurance.

“(1) An employer or union shall comply with a notice to enroll issued by the office under Section 62A-11-326.1 by enrolling the dependent child that is the subject of the notice in the:

(a) accident and health insurance plan in which the parent or legal guardian is enrolled, if the plan satisfies the prior court or administrative order; or

(b) least expensive plan, assuming equivalent benefits, offered by the employer or union that complies with the prior court or administrative order which provides coverage that is reasonably accessible to the dependent child.

(2) The employer, union, or insurer may not refuse to enroll a dependent child pursuant to a notice to enroll because a parent or legal guardian has not signed an enrollment application.

(3) Upon enrollment of the dependent child, the employer shall deduct the appropriate premiums from the parent or legal guardian's wages and remit them directly to the insurer.

(4) The insurer shall provide proof of insurance to the office upon request.

(5) The signature of the custodial parent of the insured dependent is a valid authorization to the insurer for purposes of processing any insurance reimbursement claim.

 

R527-201-10 states:

“3. When appropriate, ORS/CSS shall send the NMSN to the obligated parent's employer within two business days after the name of the obligated parent has been entered into the registry of the State Directory of New Hires, matched with ORS/CSS records, and reported to ORS/CSS in accordance with Subsection 35A-7-105(2).

4. The employer shall transfer the NMSN to the appropriate group health plan for which the children are eligible within twenty business days of the date of the NMSN if all of the following criteria are met:

a. the obligated parent is still employed by the employer;

b. the employer maintains or contributes to plans providing dependent or family health coverage;

c. the obligated parent is eligible for the coverage available through the employer; and

d. state or federal withholding limitations, prioritization, or both, do not prevent withholding the amount required to obtain coverage.”

 

1.                   The employer must complete the Employer Response section and return it to Child Support Services (CSS) within 20 business days of the date of the NMSN if:

a.                   Health coverage is not offered through the employer:

b.                  The NCP/CP is not eligible for health insurance; e.g., s/he is part-time or there is a probationary time period; and/or,

c.                   The NCP/CP has terminated employment.

 

2.                   If family health coverage is available, the employer must:

a.                   Transfer a copy of the NMSN – Part B and the Plan Administrator Response to the appropriate Plan Administrator of each group health plan for which the child(ren) may be eligible for within 20 business days of receipt of the NMSN; and,

i.                     45 CFR 303.32(c)(3) states:

Employers must transfer the NMSN to the appropriate group health plan providing any such health care coverage for which the child(ren) is eligible (excluding the severable Notice to Withhold for Health Care Coverage directing the employer to withhold any mandatory employee contributions to the plan) within twenty business days after the date of the NMSN.

ii.                   R527-201-10 states:

“4. The employer shall transfer the NMSN to the appropriate group health plan for which the children are eligible within twenty business days of the date of the NMSN if all of the following criteria are met:

a. the obligated parent is still employed by the employer;

b. the employer maintains or contributes to plans providing dependent or family health coverage;

c. the obligated parent is eligible for the coverage available through the employer; and

d. state or federal withholding limitations, prioritization, or both, do not prevent withholding the amount required to obtain coverage.”

b.                  Upon notification from the Plan Administrator that the child(ren) is enrolled, either:

i.                     Deduct the insurance premium from the NCP/CP’s wage and send it directly to the insurer; or,

A.                  45 CRF 303.32(4) states:

“Employers must withhold any obligation of the employee for employee contributions necessary for coverage of the child(ren) and send any amount withheld directly to the plan. ”

B.                  R527-201-10 states:

“6. The employer shall determine if the necessary employee contributions for the insurance coverage are available. If the amounts necessary are available, the employer shall begin withholding when appropriate and remit directly to the plan.”

ii.                   Complete the Employer Response section notifying CSS that enrollment cannot be completed because the NCP/CP’s monthly out-of-pocket cost for the insurance premium exceeds the amount allowed under the Consumer Credit Protections Act (CCPA).

 

3.                   If the employer is notified by the Plan Administrator that the NCP/CP is subject to a probationary period of more than 90 days from the receipt of the NMSN – Part B, the employer must notify the Plan Administrator when the NCP/CP is eligible to enroll in the plan and to enroll the child(ren).

 

4.                   The employer may not withhold more than the amounts allowed by the Federal Consumer Credit Protection Act (CCPA).

 

5.                   R527-201-7 Reasonable Cost of Insurance Premiums states:

“Employment-related or other group coverage that does not exceed 5% of the obligated parent's monthly gross income is generally considered reasonable in cost. However, an employer may not withhold more than the lesser of the amount allowed under the Consumer Credit Protection Act, the amount allowed by the state of the employee's principal place of employment, or the amount allowed for health insurance premiums by the child support order. If the combined child support and medical support obligations exceed the allowable deduction amount, the employer shall withhold according to the law, if any, of the state of the employee's principal place of employment requiring prioritization between child support and medical support. If the employee's principal place of employment is in Utah, the employer shall deduct current child support before deducting amounts for health insurance coverage. If the amount necessary to cover the health insurance premiums cannot be deducted due to prioritization or limitations on withholding, the employer shall notify ORS/CSS.”

 

6.                   If the employer is currently withholding money to satisfy a child support obligation and the inclusion of a monthly insurance premium amount causes the employer to exceed the CCPA limits, the employer should not enforce the medical support (NMSN) and only enforce the current support obligation.

 

The employer should complete and return the Employer Response page of the NMSN to CSS indicating that withholding limits exceed the CCPA limits and therefore, prevents the employer form withholding the insurance premium.  Once you receive the Employer Response form:

a.                   Contact the employer to get the employee’s:

i.                     Out-of-pocket cost of the monthly insurance premium; and,

ii.                   Rate of pay.

b.                  Review the case to verify that the current support (listed in the withholding order) and the insurance premium amount exceed the CCPA limits.

c.                   Update the system.

 

7.                   The employer must continue to withhold the monthly insurance premium from the NCP/CP’s wages unless:

a.                   The employer is provided with written evidence that:

i.                     The court or administrative child support order is no longer valid or in effect; or,

ii.                   The child(ren) is enrolled in a comparable coverage that will be effective no later than the effective date of disenrollment from this plan; or,

b.                  The employer eliminates family health coverage for all of its employees.

 

8.                   The employer may be subject to sanctions or penalties for:

a.                   Discharging an NCP/CP from employment;

b.                  Refusing to employ an NCP/CP;

c.                   Taking disciplinary action against an NCP/CP;

d.                  Failing to withhold income for insurance coverage; or,

e.                  Failing to transmit withheld amounts to the applicable insurance plan.

 

9.                   The employer must notify CSS promptly when/if the NCP/CP terminates employment.

 

 

Plan Administrator Responsibility – NMSN – Part B

 

A Plan Administrator must consider a NMSN issued by CSS as a qualified medical child support order (QMCSO) as long as the notice includes the names and mailing address of the NCP/CP and child(ren).  Within 40 business days of the date of the NMSN the Plan Administrator must complete the steps listed below.

 

1.                   Complete the Plan Administrator Response and send it to CSS.

 

NOTE:  When you receive the response form back from the Plan Administrator, immediately add the insurance information to ORSIS so that the CP will be notified.  If the insurance information you receive is not medical; e.g., vision only, do not add it to ORSIS.  Make a case narrative documenting the information you received and manually generate an insurance notification letter to the CP.

 

2.                   Determine if there is more than one option under the plan that is available to the NCP/CP that the child(ren) may be enrolled in, in accordance with R527-201-10(5):

“If more than one coverage option is available under a group insurance plan and the obligated parent is not already enrolled, ORS/CSS in consultation with the custodial parent may select the least expensive option if the option complies with the child support order and benefits the children…”

a.                   One Option – The Plan Administrator must enroll the child(ren) in the insurance plan, notify the NCP of the effective date of coverage of the child(ren), and, provide and/or furnish the CP with the following information:

i.                     A description of the coverage;

ii.                   The effective date of coverage; and,

iii.                  Any forms, documents, or information necessary to use the coverage.

b.                  Multiple Options – The employer/union shall enroll the dependent child(ren) in the least expensive plan in accordance with Subsection 62A-11-326.2(1)(b) unless another option is specified by ORS/CSS.  Within 20 days of returning the Plan Administrator Response, the Plan Administrator must notify the NCP of the effective date of coverage of the child(ren), and provide and/or furnish the CP with the following information:

i.                     A description of the coverage;

ii.                   The effective date of coverage; and,

iii.                  Any forms, documents, or information necessary to use the coverage.

c.                   Option(s) Limited – If some or all of the insurance options are limited to a specific geographic area, the Plan Administrator must allow the child(ren) to enroll if the obligated parent is ordered in accordance with U.C.A .31A-8-502, which states:

(1) (a) The requirements of Subsection (2) apply to a health maintenance organization if the health maintenance organization plan:

(i) restricts coverage for nonemergency services to services provided by contracted providers within the organization's service area; and

(ii) does not offer a benefit that permits members the option of obtaining covered services from a non-contracted provider.

(b) The requirements of Subsection (2) do not apply to a health maintenance organization if:

(i) the child that is the subject of a court or administrative support order is over the age of 18 and is no longer enrolled in high school; or

(ii) a parent's employer offers the parent a choice to select health insurance coverage that is not a health maintenance organization plan either at the time of the court or administrative support order, or at a subsequent open enrollment period. This exemption from Subsection (2) applies even if the parent ultimately chooses the health maintenance organization plan.

(2) If a parent is required by a court or administrative support order to provide health insurance coverage for a child who resides outside of a health maintenance organization's service area, the health maintenance organization shall:

(a) comply with the provisions of Section 31A-22-610.5;

(b) allow the enrollee parent to enroll the child on the organization plan;

(c) pay for otherwise covered health care services rendered to the child outside of the service area by a noncontracted provider:

(i) if the child, noncustodial parent, or custodial parent has complied with prior authorization or utilization review otherwise required by the organization; and

(ii) in an amount equal to the dollar amount the organization pays under a noncapitated arrangement for comparable services to a contracting provider in the same class of health care providers as the provider who rendered the services; and

(d) make payments on claims submitted in accordance with Subsection (2)(c) directly to the provider, custodial parent, the child who obtained benefits, or state Medicaid agency.

(3) (a) The parents of the child who is the subject of the court or administrative support order are responsible for any charges billed by the provider in excess of those paid by the organization.

(b) This section does not affect any court or administrative order regarding the responsibilities between the parents to pay any medical expenses not covered by accident and health insurance or a health maintenance organization plan.

(4) The commissioner shall adopt rules as necessary to administer this section and Section 31A-22-610.5.

 

If a Substitute Official’s name and address have been substituted for the address of the CP and child(ren), the Plan Administrator must:

i.                     Provide appropriate information to CSS which will allow CSS to determine if there is coverage that is accessible to the child(ren); or,

ii.                   If the only available plan is geographically limited and the child(ren) is outside of the service area, enroll the child(ren) unless notified by CSS not to.

d.                  Option Outside Coverage Area – If the insurance option selected does not provide coverage for the child(ren), or the child(ren) is outside of the service area, the Plan Administrator must notify CSS that the CP may need to select another option to enroll the child(ren).

 

3.                   Determine if the NCP/CP is subject to a probation period that is longer than 90 days from the date of receipt of the NMSN – Part B and notify CSS, the employer, the NCP and the CP.

 

NOTE:  It is the employer’s responsibility to notify the Plan Administrator when the NCP/CP’s probation time period is up and to complete enrollment of the child(ren).

 

4.                   After enrolling the child(ren) in an insurance plan, the Plan Administrator must:

a.                   Transfer all applicable information on the NMSN – Part B to the employer to determine if the NCP/CP is able to pay the monthly premium;

b.                  Inform  the employer that the enrollment is pursuant to a NMSN;

c.                   Notify the CP of the name of the child(ren) covered on the policy, including the effective date of coverage; and,

d.                  Provide the CP with a description of the coverage available, any forms or documents necessary to effectuate coverage, and all information needed to submit claims for benefits.

 

NOTE:  If the CP contacts CSS and indicates that s/he did not receive this information from the Plan Administrator, send the National Medical Support Notice Reminder to the Plan Administrator.  This letter reminds the Plan Administrator to provide the CP with a description of the available coverage, the effective date of the coverage, a summary plan description, and any forms, documents, or information necessary to effectuate such coverage, as well as information necessary to submit claims for benefits.

 

5.                   The Plan Administrator determines if the NMSN meets the criteria for a QMCSO within 40 business days of the date of the notice, or sooner if reasonable.  If the NMSN does not constitute a QMCSO, the Plan Administrator must complete the Plan Administrator Response to notify CSS, the NCP/CP and child(ren) of the reason for their determination.

 

NOTE:  If you receive this determination or any other appropriate notification, you must immediately notify the CP by making a copy of the Plan Administrator Response, if appropriate, and sending it to him/her.

 

6.                   The Plan Administrator may not deny enrollment based on UCA 31A-22-610.5 that states:

“(4) (a) When a parent is required by a court or administrative order to provide health insurance coverage for a child, an accident and health insurer may not deny enrollment of a child under the accident and health insurance plan of the child's parent on the grounds the child:

(i) was born out of wedlock and is entitled to coverage under Subsection (5);

(ii) was born out of wedlock and the custodial parent seeks enrollment for the child under the custodial parent's policy;

(iii) is not claimed as a dependent on the parent's federal tax return; or

(iv) does not reside with the parent or in the insurer's service area.

(b) A child enrolled as required under Subsection (4)(a)(iv) is subject to the terms of the accident and health insurance plan contract pertaining to services received outside of an insurer's service area. A health maintenance organization shall comply with Section 31A-8-502.”

 

7.                   If the plan requires that the NCP/CP be enrolled in order for the child(ren) to be enrolled, the Plan Administrator must enroll both the NCP/CP and the child(ren).  All enrollments must be made without regard to open season restrictions.

 

8.                   The Plan Administrator must send payment for covered benefits or reimbursement directly to the child’s CP, legal guardian, the provider of service to the child, or a state agency if the child’s rights have been assigned (receiving Medicaid assistance).

 

9.                   The Plan Administrator must continue to cover the child(ren) until the child(ren) is no longer eligible for coverage under the terms of the plan.  The child(ren) may not be disenrolled unless:

a.                   The Plan Administrator is provided satisfactory written evidence that either:

i.                     The court or administrative child support order is no longer valid or in effect; or,

ii.                   The child(ren) is enrolled in a comparable coverage which will be effective no later than the effective date of disenrollment form this plan;

b.                  The employer eliminates family health coverage for all of its employees; or,

c.                   Any available continuation coverage is not elected, or the period of such coverage expires.