Determination of a NMSN

What Happens If the NMSN Is Approved

• The Qualified Order Center will send a notice to all people in the notice and their designated representatives informing them the National Medical Support Notice (NMSN) is approved.
• The child(ren) will be eligible to receive the health care coverage described in the NMSN on the date indicated in the Part B Plan Administrator Response, enclosed with the determination letter.
• Coverage will follow the employer-specific plan rules concerning a start date. Unless specified in the NMSN, coverage will end when the child is no longer eligible based on the provisions of the plan.
• The employee's existing coverage may be changed due to the NMSN. This may occur, for example, if the NMSN specifies enrollment in a particular plan and the employee was enrolled in another plan.
• A Confirmation of Benefits statement will be sent to the employee if there is any change in his or her coverage.
• If the employee chose no coverage, the state agency will be given 20 business days to choose coverage. If the Qualified Order Center doesn't receive the state agency's response within 20 business days, the employee and child(ren) will be enrolled in the default coverage the employer assigns.

What Happens If the NMSN Is Denied

• The Qualified Order Center will notify all people named in the NMSN and their designated representatives that the NMSN is denied.
• The notice will indicate the reasons the NMSN was denied.
• The plan won't cover medical expenses incurred by child(ren) until the plan receives a NMSN that is qualified.
• The state agency may revise and resubmit the fully completed NMSN for review to:

  Qualified Order Center
  PO Box 299082
  Lewisville, TX 75029-9082
  Fax: (847) 442-0899

• A determination of the revised NMSN will be made 15 business days after it's received.