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.
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.