National Medical Support Notice (NMSN) When a National Medical Support Notice (NMSN) requires a subscriber to provide health plan coverage for a dependent child, the following provisions apply: The subscriber may enroll their dependent child and request changes to their health plan coverage as described under “Changes to health plan coverage or enrollment are allowed as directed by the NMSN,” below. • An employee must use Benefits 24/7 (once available) or submit the required form(s) to their employing agency. • Any other subscriber must use Benefits 24/7 (once available) or submit the required form(s) to the PEBB Program. If the subscriber fails to request enrollment or health plan coverage changes as directed by the NMSN, the employing agency or the PEBB Program may make enrollment or health plan coverage changes according to “Changes to health plan coverage or enrollment are allowed as directed by the NMSN,” below, upon request of: • The child’s other parent. • A child support enforcement program. Changes to health plan coverage or enrollment are allowed as directed by the NMSN: A. The dependent will be enrolled under the subscriber’s health plan coverage as directed by the NMSN. B. An employee who has waived PEBB medical will be enrolled in medical as directed by the NMSN, in order to enroll the dependent. C. The subscriber’s selected health plans will be changed if directed by the NMSN. D. If the dependent is already enrolled under another PEBB subscriber, the dependent will be removed from the other health plan coverage and enrolled as directed by the NMSN. E. If the dependent is enrolled in both PEBB medical and School Employee Benefits Board (SEBB) medical as a dependent and there is an NMSN in place, enrollment will be in accordance with the NMSN. F. If the subscriber is eligible for and elects Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage or other continuation coverage, the NMSN will be enforced and the dependent must be covered in accordance with the NMSN. Changes to health plan coverage or enrollment as described above in A through C will begin the first day of the month following receipt of the NMSN. If the NMSN is received on the first day of the month, the change to health plan coverage or enrollment begins on that day. A dependent will be removed from the subscriber’s health plan coverage as described above in D the last day of the month the NMSN is received. If that day is the first of the month, the change in enrollment will be made the last day of the previous month. When a NMSN requires a subscriber’s spouse, former spouse, or other individual to provide health plan coverage for a dependent who is already enrolled in the subscriber’s PEBB coverage, and that health plan coverage is in fact provided, the dependent may be removed from the subscriber’s PEBB health plan coverage prospectively. Dual enrollment A subscriber and their dependents may each be enrolled in only one PEBB medical plan. 2024 UMP Plus–UW Medicine ACN (PEBB) Certificate of Coverage 143