National Medical Support Notice (NMSN)

Medical Support

By law, every order for child support must include a health insurance provision. If an employee or independent contractor is a noncustodial parent and eligible for health insurance, his/her children must be enrolled in the employer’s health insurance plan whenever the noncustodial parent is ordered to provide health insurance coverage.  Health insurance must be provided to the employee’s children even if the employee declines his/her own personal health coverage. 

Medical support orders may be for a specific dollar amount included on the IWO or as an order to provide health insurance that employers are noticed via a document titled: The National Medical Support Notice (NMSN) (form OMB 0970-0222). The NMSN is a standardized federal form that all state IV-D child support programs must use. The NMSN may accompany an IWO or it may be sent separately.

2015 Changes to the IWO and NMSN Packets

On October 26, 2015, changes were implemented to the National Medical Support Notice (NMSN) form packets. Benefits include less paper, increased efficiency and better results.

The changes made to the packets are outlined below:

IWO and NMSN forms that employers need are available at “Income Withholding Order (IWO) & National Medical Support Notice (NMSN) Forms."

  • Notify the local child support agency (LCSA) within 10 business days of any lapse of health care coverage, including:
    • The reason for lapse in coverage
    • Whether the lapse is temporary
    • If the lapse is temporary, the date coverage will resume
    • The effective date of the lapse in coverage

This information should be submitted to the LCSA on the Termination of Benefits/Employment Notice (DCSS 0114) which must be obtained online.

For more information: