health insurance assignment order dcss 0361

National Medical Support Notice (NMSN) FAQs

Add remove is the health insurance order different from the child support order.

Yes, the child support order is a fixed dollar amount that your employee has been ordered to pay; whereas, the health insurance order obligates the employee to enroll their dependent in a health insurance plan.

add remove Do I have to enroll the dependent(s) into a health insurance plan even if our employee declines coverage?

Yes, you are required to enroll the dependent(s) if the Non-Custodial Parent is court ordered to provide health insurance coverage.

Note:  Health insurance must be provided to the employee’s children even if the employee declines his/her own personal health coverage.

add remove What if the combined costs of the child support and health care coverage premium exceeds 50% of the employee’s disposable earnings?

Complete NMSN Employer Response (Part A), number 5 and return it to our office, along with copies of at least the previous three paystubs, within 20 business days for further review. We will review the case to determine if the employee can afford the child support payment and health care coverage.

add remove With regards to income withholding limitations in reviewing for a medical hardship, do I use either the 5% or 50% rule?

Generally, the 50% rule is used for withholdings and 5% is used for the medical hardship review; however, we will also take into account the 50% withholding rule if a Non-Custodial Party does not qualify for a hardship under the 5% rule.

add remove If my employee states their child already has health insurance coverage but has not provided proof or contacted the local child support agency, do I enroll the child into the health insurance plan?

Yes, proceed with enrolling the child unless you receive a termination notice from our office. If the employee has any questions or issues please encourage them to contact the local child support agency (LCSA).

add remove On our health insurance plan, I cannot enroll the children without the employee being enrolled.

You will need to enroll your employee and the dependent(s). However, if you believe it may cause a hardship for the employee, you may contact the local child support agency (LCSA) and request health insurance hardship review.

add remove Am I required to enroll the child(ren) when health insurance coverage is not available in the state where the child(ren) reside?

Family Code 1063(g) defines a health insurance policy inaccessible when an employer or healthcare plan administrator provides documentation the child(ren) live outside of the coverage area. Primary health care services must be within the 50-mile radius. State regulations allow the local child support agency to determine when health insurance is inaccessible.

add remove Does the 5% limitation rule only apply to the child’s premium cost?

No, it applies to the difference in cost of health coverage for the employee and the employee plus the dependent(s).

add remove We have a third-party vendor that sends out COBRA notices. Do they need to send notices to CSS?

Yes, third party vendor is required to send COBRA notices to the LCSA and the LCSA will forward the COBRA documents to the custodial parent.

add remove If my employee does not elect to have health insurance benefits through our company can they obtain their own private insurance?

Yes, the employee can obtain private health coverage for the dependent(s) as long as the health insurance carrier is not state or government funded. The employee has to submit this information to the LCSA and, if the coverage is valid, an NMSN termination will be sent to the employer.

add remove How does an employer complete the DHS 6110 form?

When the minor child(ren) will be enrolled in any dental, vision or medical insurance plan the employer must complete items 20 through 24 of the DHS 6110 form. The employer must also complete the 'Additional Health Insurance Policy Information' section and check the "Absent Parent" box (item 20).

add remove Can I contact LCSA via telephone or email to provide health insurance information instead of completing the forms?

Yes, you may contact us to provide health insurance information via telephone or email once the enrollment is complete. When communicating electronically, ensure transmission is secure.

add remove As an employer, what do I do when the insurance provider does not provide an ID card after the employees and/or child have been enrolled?

Forward that information to the LCSA and we will contact the provider to obtain the information. Sometimes, the provider provides medical information to the employee, not the employer.

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Child Support Services Riverside County

Health insurance, health insurance coverage assignment.

A health insurance coverage assignment is an administrative order that requires the noncustodial parent’s employer (or other person providing health insurance to the noncustodial parent) to enroll the child(ren) in the parent’s health insurance plan. The order also authorizes the employer to deduct the cost of the health care premiums from the noncustodial parent's earnings.

Employer Responsibilities

Copy noncustodial parent.

The employer must deliver a copy of the National Medical Support Notice (NMSN), along with a written statement of the noncustodial parent’s rights and relevant procedures under the law to move to quash the order to the noncustodial parent within 10 days of receipt.

Determine Commencement: Date of Coverage

Employers must determine the earliest possible coverage commencement date by considering the following guidelines.

• If the employer has not received a notice of motion seeking to quash the order, then the employer must take steps to commence coverage no later than 30 days after receipt of the NMSN.
• If the employer has received a motion to quash, then the employer must hold the NMSN until receipt of the order resolving the motion to quash.

Provide Information

The employer must do the following:

• Notify our office of the commencement date of the coverage;
• Provide evidence of coverage and any information necessary for the child to obtain benefits through the coverage to both parents or the person having custody of the child and our office; and
• Upon request by the parents or person having custody, provide all forms and other documentation necessary for the purpose of submitting claims to the insurance carrier.

Disclosure (HIPPA)

Disclosure of protected health information by a health plan is permitted under Health Insurance Portability and Accountability Act (HIPPA) in response to a request for information by a IV-D agency pursuant to a National Medical Support Notice (NMSN). Please see OCSE PIQ-2004-03 for more information.

Selecting Coverage

If the noncustodial parent has not enrolled in an available health plan, there is a choice of coverage and the court has not ordered coverage by a specific plan, the employer shall enroll the child in a plan that will provide reasonable benefits or coverage where the child resides. If that coverage is not available, the employer will return the National Medical Support Notice (NMSN) to our office within 20 days.

If the noncustodial parent has selected a health insurance plan prior to the issuance of a court order, the noncustodial parent’s selection will not be superseded unless the child will not be provided benefits or coverage where the child resides or the court order specifically directs other health coverage.

When Coverage is Not Available

When coverage is not available, the employer will return the NMSN to our office within 20 days of receipt.

Lapse of Coverage

The employer must notify our office if:

• There is lapse in coverage; and if so,
• The reason for the lapse, and
• If the lapse is temporary, provide date coverage is expected to resume.

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Health Insurance Assignment Order

It wasn’t bad enough that your wages were garnished. Now your employer is telling you that another chunk of your salary is going to be taken out to cover health insurance for your kids. But your kids are already covered through your ex. But your kids are already on Medical. But the cost is too high! Neither one is relevant as far your employer is concerned. As long as the cost does not go above 50% of your income, your employer HAS to add your kids to the available health insurance coverage. There is nothing you can do about it, right? Not quite.

The rule is that you have to provide health insurance as long as it is available to you at a reasonable cost. Reasonable cost did not used to be defined. However, a couple of years ago, the Family Code was amended to define it as follows: there is a “rebuttable presumption” that the cost is reasonable as long as it does not “exceed 5 percent” of your income to add the children. Family Code §3751(a)(2). So the 5% does NOT include the cost of health insurance for you. But only what it costs to add them.

You also have to note that the 5% is not a blanket rule but a rebuttable presumption. In other words, an obligor can have a higher than a 5% cost and the court can still make the obligor provide health insurance coverage. The 5% showing simply creates a presumption that the cost is unreasonable, and then the party seeking the coverage (the other parent or the DCSS) has to rebut that presumption. So, again, note that under Family Code section 3761, there is no requirement that the employer calculate the 5% for the purpose of determining whether the dependent ought to be added or not. That is a  judicial function  if the obligor objects to the cost.

Let us review your paycheck for ways to save you money!

The process to quash the health insurance assignment is to request a hearing with the court. While not that complicated, the DCSS has attorneys representing the county’s interest, it is always recommended to have an attorney on your side to dispute the health insurance assignment order. If you need help please call our office. Since it is a relatively routine process, we can provide affordable rates and possibly even flat rates to take care of this matter for you. While we are reviewing your paycheck, we can also review to see if you should file for modification.

Call us for a  free consultation . We have offices in  Riverside ,  Temecula ,  Anaheim , and  Palm Desert . Call now for an appointment with an attorney. We have  attorneys  that can handle cases in Riverside, San Bernardino, Orange and Los Angeles Counties.

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Healthcare in Moscow – Personal and Family Medicine

Emergency : 112 or 103

Obstetric & gynecologic : +7 495 620-41-70

About medical services in Moscow

Moscow polyclinic

Emergency medical care is provided free to all foreign nationals in case of life-threatening conditions that require immediate medical treatment. You will be given first aid and emergency surgery when necessary in all public health care facilities. Any further treatment will be free only to people with a Compulsory Medical Insurance, or you will need to pay for medical services. Public health care is provided in federal and local care facilities. These include 1. Urban polyclinics with specialists in different areas that offer general medical care. 2. Ambulatory and hospitals that provide a full range of services, including emergency care. 3. Emergency stations opened 24 hours a day, can be visited in a case of a non-life-threatening injury. It is often hard to find English-speaking staff in state facilities, except the largest city hospitals, so you will need a Russian-speaking interpreter to accompany your visit to a free doctor or hospital. If medical assistance is required, the insurance company should be contacted before visiting a medical facility for treatment, except emergency cases. Make sure that you have enough money to pay any necessary fees that may be charged.

Insurance in Russia

Travelers need to arrange private travel insurance before the journey. You would need the insurance when applying for the Russian visa. If you arrange the insurance outside Russia, it is important to make sure the insurer is licensed in Russia. Only licensed companies may be accepted under Russian law. Holders of a temporary residence permit or permanent residence permit (valid for three and five years respectively) should apply for «Compulsory Medical Policy». It covers state healthcare only. An employer usually deals with this. The issued health card is shown whenever medical attention is required. Compulsory Medical Policyholders can get basic health care, such as emergencies, consultations with doctors, necessary scans and tests free. For more complex healthcare every person (both Russian and foreign nationals) must pay extra, or take out additional medical insurance. Clearly, you will have to be prepared to wait in a queue to see a specialist in a public health care facility (Compulsory Medical Policyholders can set an appointment using EMIAS site or ATM). In case you are a UK citizen, free, limited medical treatment in state hospitals will be provided as a part of a reciprocal agreement between Russia and UK.

Some of the major Russian insurance companies are:

Ingosstrakh , Allianz , Reso , Sogaz , AlfaStrakhovanie . We recommend to avoid  Rosgosstrakh company due to high volume of denials.

Moscow pharmacies

A.v.e pharmacy in Moscow

Pharmacies can be found in many places around the city, many of them work 24 hours a day. Pharmaceutical kiosks operate in almost every big supermarket. However, only few have English-speaking staff, so it is advised that you know the generic (chemical) name of the medicines you think you are going to need. Many medications can be purchased here over the counter that would only be available by prescription in your home country.

Dental care in Moscow

Dentamix clinic in Moscow

Dental care is usually paid separately by both Russian and expatriate patients, and fees are often quite high. Dentists are well trained and educated. In most places, dental care is available 24 hours a day.

Moscow clinics

«OAO Medicina» clinic

It is standard practice for expats to visit private clinics and hospitals for check-ups, routine health care, and dental care, and only use public services in case of an emergency. Insurance companies can usually provide details of clinics and hospitals in the area speak English (or the language required) and would be the best to use. Investigate whether there are any emergency services or numbers, or any requirements to register with them. Providing copies of medical records is also advised.

Moscow hosts some Western medical clinics that can look after all of your family’s health needs. While most Russian state hospitals are not up to Western standards, Russian doctors are very good.

Some of the main Moscow private medical clinics are:

American Medical Center, European Medical Center , Intermed Center American Clinic ,  Medsi , Atlas Medical Center , OAO Medicina .

Several Russian hospitals in Moscow have special arrangements with GlavUPDK (foreign diplomatic corps administration in Moscow) and accept foreigners for checkups and treatments at more moderate prices that the Western medical clinics.

Medical emergency in Moscow

Moscow ambulance vehicle

In a case of a medical emergency, dial 112 and ask for the ambulance service (skoraya pomoshch). Staff on these lines most certainly will speak English, still it is always better to ask a Russian speaker to explain the problem and the exact location.

Ambulances come with a doctor and, depending on the case, immediate first aid treatment may be provided. If necessary, the patient is taken to the nearest emergency room or hospital, or to a private hospital if the holder’s insurance policy requires it.

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