This is a very important law that applies to any college student that upon turning 22 or whatever age their health insurance knocks them off of their parents plan that gives them a right to continue as dependents on their parents health insurance. Right now it is only for one year but I hope they change that law as I don’t believe that is long enough.
Seriously ill college students, covered as dependents, can continue their coverage for up to one year if a doctor orders a medically necessary leave of absence, as mandated by Michelle’s Law.
The law, signed by President Bush on Oct. 8, 2008, applies to both group and individual health plans effective October 9, 2009. Group health plans with a calendar year plan must comply starting January 1, 2010. In addition, self-funded groups are required to comply, unless they opt out of coverage required by Michelle’s Law.
Health plans are required to keep the dependent’s coverage active during a medically necessary leave of absence until:
- One year after the first date of the medically necessary leave of absence, or
- The date coverage would otherwise terminate under the plan
In addition to these requirements, three additional criteria must be met:
- Physician Certification – Written certification from the treating physician that the dependent has a serious illness and/or injury requiring a medically necessary leave of absence.
- Notice – The health plan must provide a notice describing the terms
of maintaining their coverage and the notice must be written in a way that a typical covered person would find understandable. Further,
the notice will be included with any notice regarding a requirement
for certification of student status under the health plan. - Benefits – Coverage will remain the same as prior to the medically necessary leave of absence, except if there are changes in: coverage, insurance carrier, and/or fully insured to self funded or vice versa.
Below are answers to questions regarding Michelle’s Law:
What conditions would apply to the medically necessary leave of absence?
- Medically necessary leave of absence for a dependent enrolled in a post-secondary educational institution: begins due to a serious illness or injury, is medically necessary, and causes the child to lose student status under the terms of the plan.
Can an insurance carrier validate treatment?
- Yes. An insurance carrier can validate treatment and validate that the medically necessary leave of absence is ordered by the treating physician.
What if the state does not have eligibility requirements tied to full time student status?
- Michelle’s law does not impact a plan if the state does not permit termination of a dependent child when the child is no longer a full-time student.
Are multiple leaves of absence covered or only one, twelve month period?
The law was named after Michelle Morse, a college student who suffered from cancer and continued her course load, against the advice of doctors, in order to remain covered by health insurance.
Michelle’s law provides that a group health plan may not terminate a college student’s health coverage simply because the child takes a medically necessary leave of absence from school or changes to part-time status. The leave of absence must:
- Be medically necessary;
- Commence while the child is suffering from a serious illness or injury; and
- Cause the child to lose coverage under the plan.
To take advantage of the extension, the child must have been enrolled in the group health plan on the basis of being a student at a post-secondary educational institution immediately before the first day of the leave. Coverage must extend for one year after the first day of the leave (or, if earlier, the date coverage would otherwise terminate under the plan). The student on leave is entitled to the same benefits as if they had not taken a leave. If coverage changes during the student’s leave, then this new law applies in the same manner as the prior coverage.
Physician’s Certification and Notice
The group health plan must receive written certification by the child’s treating physician stating the child is suffering from a serious illness or injury, and the leave (or change of enrollment) is medically necessary. In addition, when sending any notice describing the plan’s student certification requirements for coverage, the plan also must include a description of the terms for continued coverage under this law.
Effective Date
Michelle’s Law is effective for plan years beginning on or after October 9, 2009.
