Provisions Effective For Plan Years Beginning On Or After October 3

by Maria Anastas, Ogletree Deakins (San Francisco)


Michelle's Law provides that a group health plan that offers dependent coverage and conditions that coverage upon status as a full-time student may not terminate the dependent's coverage when the dependent ceases to meet the "full-time" criteria due to a "medically necessary leave of absence." This law is intended to protect parents of college students who lose "student status" due to illness from the financial burdens of COBRA.

The plan must permit students at a postsecondary educational institution who lose full-time status to continue coverage until the earlier of (1) one year after the first day of the medically necessary leave of absence or (2) the day that the student's coverage would have otherwise ended. A "medically necessary leave of absence" includes an actual leave of absence from the postsecondary educational institution, as well as any other change in enrollment at the institution that: (1) begins while the student is suffering from a serious illness or injury; (2) is medically necessary; and (3) causes the loss of student status under the terms of the plan or health insurance coverage. A postsecondary educational institution is a public or private institution offering two- and four-year degree programs, but many occupational education and postsecondary vocational programs and, in limited cases, comparable institutions outside of the U.S., will qualify.

The law requires health plans to continue coverage on the same terms as coverage is provided for other dependent children. Any change in health insurance coverage, insurer, or funding that occurs while the student is on a medically necessary leave of absence must carry over to the student.

The provisions of Michelle's Law are effective for plan years beginning on or after October 3, 2009; therefore, plans operating on a calendar year will need to be amended effective January 1, 2010. Employers should also revise their summary plan descriptions to provide for this coverage.

Note: This article was published in the May/June 2009 issue of The Employment Law Authority.