Michelle’s Law (U.S. HR 2851)
[Below Excepted from Recent Carrier Communication]
On October 9, 2008, President Bush signed into law H.R. 2851, “Michelle’s Law,” which requires group and individual health plans to continue to cover otherwise eligible dependent children who take a medical leave of absence from a postsecondary educational institution (e.g., a college, university, or vocational school) due to a serious illness or injury.
Key Provisions
The bill applies to both group and individual coverage and amends ERISA, the Public Health Service Act, and the Internal Revenue Code with substantially similar provisions:
- “Dependent child” includes a dependent child who 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 a medically necessary leave of absence.
- “Medically necessary leave of absence” triggers continued coverage for the dependent child and is defined as a leave of absence – or any other change in enrollment – that begins while a dependent child is suffering from a serious illness or injury that causes the child to lose their student status for purposes of coverage under the plan.
- Physician certification. The bill requires that health plans and insurers receive certification by the dependent child’s treating physician that the dependent child is suffering from a serious illness or injury and that the leave of absence is medically necessary.
- No change in benefits. Dependent children on a medically necessary leave of absence are entitled to receive plan benefits, and if the plan changes, these dependents are entitled to receive benefits as provided by the amended plan until their coverage ends.
- Duration of leave of absence. Dependent children on a leave of absence must be covered until the earlier of one year from the first day of the leave of absence or the date on which the coverage otherwise would terminate.
- Notice. Health plans and insurers must include a description of the requirements for continued coverage during medically necessary leaves of absence with any notice about required certifications of student’s eligibility status.
- Effective Date. Plan years beginning on or after one year from the date of enactment.