Michelle’s Law

Health Insurance Quotes

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.

Michelle’s Law offers college students stricken with a serious illness and that are covered as dependents through their parents health plans, are allowed to stay on their parents plan for up to a year if a doctor order a medical leave of absence.

Michelle’s law was signed into effect on October 8, 2008 by President Bush and it can apply to any type of health plan, be it group or individual health coverage as long as it is effective after October 9, 2009.  Group health plans that use a calendar year plan, had to comply  must comply starting January 1, 2010.  Of course self insured employers were required to comply immediately, unless they offer less coverage than is required by Michelle’s Law.

The health insurance companies are required to keep the ill students coverage active during the medical leave of absence until:

  • One year has elapsed from the date of the medically necessary leave of absence, or
  • The lapse date  the coverage would have otherwise terminated under the plan

Other requirements include:

  • 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.

FAQ on 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.

Note:

Michelle’s Law is no longer necessary due to the Affordable Care Act’s extension of coverage for dependent children up to age 26. This applies to children on their parents’ individual or group health plans, and has already helped millions of young adults in America stay insured. Whether an adult child using their parents’ health plan is living away from home, enrolled as a full-time student, or married, they are permitted to keep full benefits until their 26th birthday. There is no requirement for the child to be seriously ill or injured to receive this extension of coverage.