Job & Family Services Office of Child Support
Office of Child Support - Medical Support



Millions of children in the United States live in single parent households. Too often, the non-custodial parent is not fulfilling a legal obligation to provide health insurance. As a result, many children go without health care or must rely on the state's Medicaid program. Yet, many defaulting parents are employed and able to provide health insurance coverage. One step toward solving this problem is the recognition that child support is a partnership.

Ohio's Child Support Program is administered by the Ohio Department of Job and Family Services, Office of Child Support. Through its county child support enforcement agencies, it is responsible for establishing and enforcing health insurance orders for child support cases when coverage is available and reasonable or expected to become available. Children who might not otherwise be covered under a medical insurance plan can get the medical attention once they receive the medical support from your employee.

As an employer, your role in facilitating access to available medical coverage for these children is invaluable. Your efforts, together with the health plan administrators, and the local child support enforcement agencies will enable children to receive the coverage to which they are entitled.

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When Must The Employer Provide Medical Coverage?  

Employers must provide medical insurance coverage to an employee's child per a child support order when:

  • The employer offers family care coverage as part of its benefit plan AND
  • The employee is eligible for the family care coverage.
  • If an employer does not offer family care coverage, it is not required to obtain it simply to comply with a medical support order.

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Receiving A National Medical Support Notice (NMSN)  

The employer will receive a National Medical Support Notice (NMSN) and the accompanying JFS 03377 "Employer/Health Plan Administrator Health Insurance Verification Request" from an issuing agency which in Ohio is the county child support enforcement agency (CSEA). The NMSN is a standardized federal form that all state child support agencies use to enforce medical support orders for minor children. It was created in response to federal law [Child Support Performance and Incentive Act (CSPIA) of 1998 amended 42USC666 (a) (19)] by a work group with membership including human resource and payroll professionals, plan administrators and sponsors of group health plans, among others. This requirement is also found in section 3119.29 to 3119.56 of the Ohio Revised Code. The purpose of the NMSN is to notify the employer that the employee identified on the NMSN is obligated by a court or administrative child support order to provide health care coverage for the child(ren) identified on the Notice.

The NMSN is only required for employment based insurance coverage. It is required to be generated and sent in response to new employment discovered through the New Hire reporting process or through alternate means. The NMSN is required to be issued within two business days of a new hire match, and will go out at the same time as the income withholding for other employment discoveries.

The employer will review the Notice and respond within the designated time frames established by federal and state statute. The employer can refer to this website for current and updated information regarding the process for compliance. Under Ohio law, either the obligor/non-custodial parent or obligee/custodial parent can be ordered to provide health insurance through a child support order. Employers can expect to receive a NMSN for their employees that are custodial and non-custodial parents depending on which party was ordered to provide coverage.

The NMSN constitutes a Qualified Medical Child Support Order and meets ERISA requirements, section 609 (a)(3) and (4). The two-part document provides the name and address of the issuing agency contact. The Notice contains the issuing state's state law provisions or state policy for:

  • Withholding employee health insurance contributions
  • Priority between child support and health insurance when funds are insufficient to cover both
  • Duration of the obligation

The NMSN is actually four different documents plus instructions for the employer and the plan administrator:

Part A - Notice to Withhold for Health Care Coverage: will be completed by the child support agency to provide identifying information to the employer about the case and the employee, and will be sent to the employer with the rest of the packet.

Employer Response: is your opportunity to respond to the request if one of the following situations exist:

  • You do not provide health care coverage for your employees
  • The employee is not eligible for the health care coverage you provide
  • The employee has been terminated or has left this employment
  • The deduction for health care coverage cannot be made because of State or Federal limitations and the State's priority (included in the instructions) for withholding.

Part B - Medical Support Notice to Plan Administrator: This document must be forwarded to your health care plan administrator for handling, if the situations described above under “Employer Response” do not exist.

Plan Administrator Response: Is completed by your Plan Administrator according to the accompanying instructions and returned to the child support agency. The employer is also informed so that the premium withholding may begin.

The JFS 03377 requests the employer/health plan administrator to verify insurance information for the child(ren) subject to coverage and to provide the following information:

  • Effective date of enrollment for the child(ren)
  • Name, address, and telephone number of insurance company in which the employee and dependent(s) are enrolled
  • Insurance policy number
  • Group ID number

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Employer Responsibilities  

The NMSN should first be directed to Human Resources or Personnel.

Determine if any of the four categories on the Employer Response apply to you or this employee. You may only be able to determine whether one of the first three apply at this stage.

If so, complete the Employer Response form and return it to the Issuing agency within 20 business days.

Determine if the combined total of support withholding and insurance contributions exceed the amount permitted by CCPA. If it is impossible to deduct the premiums, the child will not be enrolled. Check number 4 on the Employer Response of the NMSN and return it to the agency. Ohio's legislation established a priority for cash support when CCPA does not permit both.

If none of the four categories on the Employer Response apply to you or this employee, forward Part B to the plan administrator (insurer) within 20 business days after the receipt of the NMSN.

If an employee has health benefits through a union, you may forward Part B to the appropriate union.

The Plan Administrator will notify you when enrollment has been completed. You must then notify your payroll to make the appropriate deductions for employee contributions required by the health plan. Employers must withhold insurance premium contributions and send them to the insurer.

If enrollment cannot be completed until after a waiting period or other contingency, you must notify the Plan Administrator when the employee is eligible for enrollment.

Notify the CSEA when the employee's employment is terminated and of any changes in or termination of health insurance coverage.

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Employee Rights  

The employee may object through the CSEA to the NMSN based on a mistake of fact. The employee may present testimony and evidence at an administrative hearing only in regard to whether a mistake of fact has been made in the NMSN. If the employee disagrees with the results of the administrative hearing, (s)he may file a written motion with the court to determine if a mistake of fact still exists in the NMSN. However, the hearing rights do not stop the withholding for premiums unless/until the employee wins his/her appeal. 

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Covered Party Responsibility  

If the insurer notifies the CSEA that health plan options exist, the covered party needs to select an option and advise the CSEA. Failure to do so will cause the insurer to select a default option.

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Medical Support Links and Resources  


Additional information for both the MI obligor and the MI obligee can be found in the Accessing Health Insurance for Child Support Kids brochure.

You may access additional information regarding medical support on the Federal Office of Child Support website at:http://www.acf.hhs.gov/programs/cse/newhire/employer/private/medical_support.htm.

You may access the National Medical Support Notice at:http://www.odjfs.state.oh.us/forms/results1.asp?stype=FORM_NUM&searchPar=OMB%.

You may access the Employer/Health Plan Administrator Health Insurance Verification Request (JFS 03377) document at:http://www.odjfs.state.oh.us/forms/results1.asp.

You may access additional information about health plan administrator responsibilities at:http://www.jfs.ohio.gov/Ocs/hpa/index.stm.

You may access the Department of Labor Compliance Guide for Qualified Medical Child Support Orders (QMCSOs) at:https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/publications/qualified-medical-child-support-orders.pdf.

You may access the Ohio medical support related frequently asked questions and answers at:https://jfs.ohio.gov/Ocs/OCSFAQs.stm.

The Ohio Administrative Code rules related to medical support can be found at:http://codes.ohio.gov/oac/5101%3A12-47.

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Last Updated 08/16/2018