Pursuant to Michelle’s Law, effective for plan years beginning on or after October 9, 2009, group health insurance plans must continue coverage, up to one year, for full-time post-secondary students that suffer a serious illness requiring a medical leave that causes them to lose full-time student status.
"Michelle's Law" allows for seriously ill or injured college students to take up to one year of medical leave without losing their health insurance. Michelle's Law is inspired by life and the memory of Michelle Morse, according to a press release from Rep. Paul Hodes (D-NH), who sponsored the bill. Michelle was a full-time college student at Plymouth State University when she was diagnosed with colon cancer. Her doctors advised her to cut back on her course load while undergoing chemotherapy, but she could not because she would lose her family's health insurance when she needed it most. Michelle died as she struggled to regain her health while going to school full-time.
Pursuant to the bill, group health plans cannot terminate coverage of a dependent child due to a medically necessary leave of absence before the date that is the earlier of: (1) the date that is one year after the first day of the medically necessary leave of absence, or (2) the date on which such coverage would otherwise terminate under the terms of the plan or health insurance coverage. A dependent child is defined in the bill as a beneficiary under the group health plan who: (1) is a dependent child, under the terms of the plan or coverage, of a participant or beneficiary under the plan or coverage and (2) was enrolled in the plan or coverage, on the basis of being a student at a postsecondary educational institution, immediately before the first day of the medically necessary leave of absence involved. The amendments made by Michelle's law shall apply with respect to plan years beginning on or after the date that is one year after the date of the enactment of the law and to medically necessary leaves of absence beginning during such plan years.
Full-time student status. The full-time post-secondary student is required to have full-time student status until the first day of the leave, be enrolled in the plan on the first day of the leave, and be a dependent child of a participant or beneficiary under the plan. School semester breaks do not disqualify the student from maintaining full-time status until the leave begins. A leave of absence of a dependent child from a post-secondary educational institution, or a change in enrollment status, that is medically necessary as a result of an illness or injury that causes the child to lose full-time student status is a medically necessary leave of absence.
Certification. The dependent child's physician must certify to the plan or issuer the nature of the child's illness and that the leave is medically necessary. For purposes of administrative or judicial proceedings, the certification creates a rebuttable presumption that the dependent child is suffering from a severe illness or injury and that a leave of absence is medically necessary.
A group health plan, and a health insurance issuer providing health insurance coverage in conjunction with a group health plan, must include an understandable description of the applicable terms for continued coverage during medically necessary leaves of absence as part of the notice describing the certification requirement.
Benefits. The dependent child is entitled to the same health benefits while on leave that she was entitled to as a full-time student. The dependent child is also entitled to benefits under any successor plan if the plan sponsor changes group health plans after the child's leave has commenced.
These provisions apply to health insurance coverage offered by a health insurance issuer in the individual market just as they apply to a health insurance issuer in regard to a group health plan in the small or large group market.
Source: ERISA Sec. 714, PHSA Secs. 2707 and 2753, and Code Sec. 9813, as added by Michelle’s Law (P.L. 110-381), signed by the president on October 9, 2008.
Reprinted with permission. © CCH
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