National Medical Notice

What is it?

The National Medical Notice is a notice that instructs the employer to enroll the child in the employees health care coverage pursuant to a court or administrative order. The notice may be sent from the instate Office of Child Support Services or Court as well as an interstate agency or court. Both federal law and state law requires the use of the National Medical Notice to enforce a health care coverage provision where appropriate. If the employer does not provide health care coverage for employee dependents, the agency does not need to send the notice to the employer. The medical notice shall instruct the employer into which health care plans the children shall be enrolled and include all identifying information of the child support case. The National Medical Notice encompasses a full set of instructions so that the employer can comply with the responsibilities as outlined in the law.

The Rhode Island Office of Child Support Services has implemented a new easy to use website for completing National Medical Support Notices online.  This website has been developed to save employers time and resources, and to dramatically decrease the amount of paper processed each year, all at no cost to employers.

To register, select the following link and follow the instructions

What are the duties of the employer to respond to the notice?

The law requires the following:

The employer must respond, within twenty (20) business days after the date of the medical notice, or sooner, if reasonable, indicating:

  • (1) That the employer does not maintain or contribute to plans providing dependent or family care coverage;
  • (2) That the employee is among a class of employees that are not eligible for family health care coverage under any group health plan maintained by the employee;
  • (3) That health care is not available because the employee is no longer employed; or
  • (4) That state or federal withholding limitations and/or prioritization prevent the withholding from the employee's income of the amount required to obtain coverage.

If family health care coverage is available, the employer is required to transfer the appropriate part of the medical notice to the plan administrator of each appropriate group health plan for which the children may be eligible.

Upon notification from the plan administrator that the children are enrolled, the employer must either:

  • (1) Withhold from the employees income any contributions required and transfer the contribution to the plan administrator; or
  • (2) Complete the appropriate employee response portion of the notice and advise the Office of Child Support Services that enrollment cannot be completed because of limitations on additional withholding of income.

If there is a waiting period for enrollment based upon number of hours worked or passage of time, the employer must notify the plan administrator when the condition is met.

What happens if the employer does not comply?

An employer may be subject to a one hundred dollar fine or other penalties under the Employee Retirement Security Act for discharging an employee from employment, for refusal to employ an individual, for taking disciplinary action, or for failure to withhold income to be applied towards the plan as the medical notice directs.

What if the health insurance is carried through the union, can the notice be sent there instead?

No. The notice must be sent to the employer. The employer will then send the notice to the union or to their plan administrator.

What is the time frame for the employer to respond to the notice?

The employer must respond within twenty (20) business days after the date of the medical notice.

What if the employee is terminated?

The employer must notify the Office of Child Support Services, 77 Dorrance Street, Providence, RI 02906 within ten (10) days of the termination.

What if there is an employee contribution required to enroll the child?

The employee is liable for any employee contributions toward the plan and the employer shall withhold the sum from the employee's wages. The employee may contest the withholding directly with the Office of Child Support Sevices based upon a mistake of fact. However, while the contest is pending and until the employer hears otherwise, the employer must continue to withhold the contribution.

Are there any limitations on withholding the contribution from the employee's wages?

There are limitations on withholding. (a) The employer may not withhold more under the medical notice than the lesser of:

  • (1) The amounts allowed by the Federal Consumer Credit Protection Act, 15 U.S.C. § 1673(b);
  • (2) The amounts allowed by the state of the employee's principal place of employment; or
  • (3) The amount allowed for health care coverage premiums by the child support order. The federal limit applies to the aggregate disposal weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as state, federal and local taxes, social security taxes, and Medicare taxes.

Priority of Withholding.

If withholding is required for employee contributions to one or more health care coverage plans under the medical notice and for a support obligation under a separate notice, and available funds are insufficient for withholding for both cash and medical support contributions, the employer must withhold amounts for purposes of cash support and medical support contributions in accordance with the law, if any, of the state of the employee's principal place of employment requiring prioritization between cash and medical support. If the principal place of employment is Rhode Island, cash support shall be a priority followed by medical support contributions.

How long must the employer continue to withhold?

The employer must withhold until the court or administrative order is no longer in effect, or the children will be enrolled in comparable health care coverage which will take effect when there is disenrollment on the existing plan, or the employer eliminates family health care coverage for all employees