Michelle’s Law goes into effect for group health plans on the first day of the plan year on or after October 9, 2009. Michelle’s Law is a federal law that prohibits a group health plan from terminating a dependent’s health coverage if the dependent requires a medically necessary leave of absence or a reduction in full-time class status from a postsecondary educational institution. The law applies to insured and self-insured group health plans for which dependent coverage is available and full-time student status determines eligibility.
Background
Michelle Morse was diagnosed with colon cancer while she was a full-time student at Plymouth State University. Her doctors recommended that she cut back on her college course load while undergoing chemotherapy. A dilemma arose between maintaining eligibility as a dependent under her mother’s group insurance coverage and cutting back her course load to undertake cancer treatment. Michelle could only be considered an eligible dependent under her mother’s group insurance coverage if she were a full-time student. COBRA continuation coverage applied; however, the COBRA premium was more than Mic
Michelle’s Law
helle’s family could afford. Michelle stayed in school while undergoing treatment and attained a 3.5 grade average. She died after her college graduation.
Michelle’s mother, AnnMarie, championed legislation to allow a brief medical leave of up to twelve months during which a student could cut back or leave college to concentrate on health needs. New Hampshire became the first state to pass such legislation. Ten other states soon followed. On October 8, 2008, George W. Bush signed H.R. 2851 making Michelle’s law a federal law effective October 9, 2009.
Compliance Requirements
For plans on a calendar year basis, this law becomes effective January 1, 2010; otherwise, the law becomes effective on or after October 9, 2009. To qualify for the leave of absence or reduction in course load:
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The student must have been covered under the parent’s group health plan immediately before the first day of the approved leave of absence.
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The leave must be medically necessary and must commence while the student is suffering from a serious illness or injury.
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The student must otherwise lose coverage due to the reduced course load or leave of absence.
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The student’s treating physician must supply written certification that the student is suffering from a serious illness or injury requiring the leave or change in enrollment status.
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Plans must provide notice of the requirements of Michelle’s Law with any notice requiring certification of student status for coverage as a dependent under the parent’s plan.
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Michelle’s Law must extend for at least one year but coverage may end earlier if the student no longer satisfies the eligibility requirements of the plan, for example, marries or ages out of the plan.
Certain aspects of the law, for example coordination with COBRA continuation coverage, have not been clarified. Michelle’s Law does not amend Internal Revenue Code section 152 (c) (3) that defines a qualifying child as not having attained age 24 if a student. For more information on Michelle’s Law, see P.L. 110-381.
Disclaimer: This material is for the sole purpose of providing general information and does not under any circumstances constitute legal advice and should not be used as a substitute for legal advice. You should seek the advice of counsel when applying the requirements to your plan. For more information on this ErisaALERT contact us by phone at 773-857-1137 and ask for Leanne Fosbre or 610-524-5351 and ask for Mary Andersen or 973-994-7539 and ask for Theresa Borzelli.
