Posted: 11.03.2008
A provision allowing continuation of health coverage for college students during a medical leave was signed into law by President Bush on October 9, 2008.
Currently
Many group health plans condition dependent eligibility on status as a full-time student for dependents between the ages of 19 and 25 or later depending on the insurance carrier terms or state law. This means that such dependents must be enrolled as a full-time student in order to retain health insurance coverage.
The New Law
Enactment of this law now prohibits group health plans from terminating coverage for a dependent student who takes a medically necessary leave of absence. The Act applies to group health plans and health insurers that issue coverage in connection with a group health plan.
New Group Health Plan Requirements
Under the new law, a group health plan must continue to provide coverage to a dependent that otherwise would lose coverage under the plan for failing to maintain full-time enrollment in a post-secondary institution in the event the dependents require a medically necessary leave of absence.
The group health plan must continue coverage for one year after the first day of the medically necessary leave, or until coverage otherwise would terminate under the plan.
The group health plan also is required to provide a notice describing the availability of the medical leave as part of the plan materials describing the student status requirements.
At the end of the year of medical leave, dependents who return to school as full-time students may continue coverage under the terms of the plan.
Coverage for dependents who do not return to school may be terminated under the terms of the plan. Loss of coverage for dependents who do not return to school likely would be considered a "qualifying event" for purposes of COBRA.
Dependent Eligibility for Coverage
To qualify for coverage under the law, (1) the dependent must suffer from a serious illness or injury (2) the dependent must lose eligibility due to the medically necessary leave; and (3) the leave must be medically necessary. To demonstrate that a dependent meets the three criteria, the dependent's treating physician must certify that dependent is suffering from a medical illness or injury and that the leave of absence is medically necessary.
Effective Dates
The new law applies to health plans governed by ERISA and is effective for plan years beginning on or after October 9, 2009. Calendar year plans must comply beginning January 1, 2010. For example, plans with an effective date of January 1, 2009 are required to comply effective January 2010.
Note: Michelle’s law was named in honor of Michelle Morse, a college student who was diagnosed with colon cancer. Michelle was required to maintain a full course load while undergoing cancer treatment in order to retain her health insurance coverage. Michelle died of colon cancer in 2005 at age 22.
