A medical leave from school should not cost a covered student their health coverage.
Michelle’s Law keeps a covered dependent student on the health plan during a medically necessary leave from school. Four short guides cover each rule.
Four Topics On One Federal Rule.
Who Michelle’s Law Protects
The dependent child, the student status that makes the child eligible and the plans that must follow the rule.
Medically Necessary Leave And Physician Certification
The three-part test for a qualifying leave and the written certification a treating physician must give.
The One-Year Limit And Continued Benefits
When continued coverage ends, what the child keeps and what happens if the carrier changes mid-leave.
Plan Documents, Notices, Age 26 And COBRA
Where the rule belongs in the plan document and SPD, and how it sits beside age-26 coverage and COBRA.
Where Things Stand.
Michelle’s Law is section 714 of the Employee Retirement Income Security Act, 29 U.S.C. 1185c. Congress added it through Public Law 110-381, signed October 9, 2008. The same text appears in section 2728 of the Public Health Service Act (42 U.S.C. 300gg-28) and section 9813 of the Internal Revenue Code (26 U.S.C. 9813), so it binds both group health plans and the insurers that sell them.
The rule is simple to state. Some plans cover an older dependent child only while the child is a full-time or otherwise qualifying student. If a serious illness or injury forces a medically necessary leave and the child loses student status, the plan may not end coverage because of that leave before the earlier of two dates: one year after the first day of the leave, or the date coverage would otherwise end under the plan.
Status: this is current law. The statute applies to plan years beginning on or after one year after October 9, 2008, which is October 9, 2009. General information, not legal advice. Check the cited sources before you act.
How A Qualifying Leave Plays Out.
Picture a college junior covered under a parent’s plan because of student status. In the middle of a term the student is diagnosed with a serious illness, and a treating physician advises withdrawing for the year. The school records the withdrawal, and the plan’s own definition of a dependent student is no longer met.
Without the rule, the plan could drop the student on the date of withdrawal. With it, the plan must keep the student covered, provided it has the physician’s written certification, until the earlier of the one-year mark or the date coverage would otherwise have ended. During that time the student receives the same benefits as if still enrolled and not on leave.
Two points trip up employers. The rule is triggered by the loss of student status, not by the illness alone, and the protection turns on paperwork the plan has actually received. Our four guides take each point in order.
What Michigan Adds.
Michigan has its own rule for insured coverage. MCL 500.2264a, added by 2006 PA 537 and effective January 1, 2007, applies to a policy or certificate delivered, issued or renewed in Michigan that covers hospital or medical care for dependent students. If a covered student takes a leave of absence from school because of illness or injury, the insurer must continue coverage for 12 months from the last day of attendance or until the dependent reaches the age when coverage would otherwise end, whichever is shorter. The attending physician must certify in writing that the leave is medically necessary, and the rate stays the dependent student rate.
The federal clock runs from the first day of the leave and the Michigan clock from the last day of attendance. We have not found published guidance that reconciles the two, so check how your carrier applies each rule. We also have not confirmed here how MCL 500.2264a applies to self-funded plans, which are generally governed by federal law.
What An Employer Can Do Now.
Read your plan document and certificate for the definition of a dependent student and for any leave-of-absence language. Confirm that the plan says what happens when a student takes a medical leave.
Check any form or notice that asks families to certify student status. If it exists, the law requires a plain-language description of this protection in it. Then give HR one written procedure: who receives the physician’s certification, who tells the carrier and who calendars the end date.
Related Rules And Tools.
Affordable Care Act for Employers
Dependent coverage to age 26 and the other employer rules in the ACA.
COBRA Election Notices After A Layoff
How COBRA notices work when coverage ends.
Why An Employee Handbook Is Not A Summary Plan Description
What the SPD must say and why a handbook does not replace it.
Michigan State Health Insurance Mandates
Michigan insurance requirements that sit beside the federal rules.
Laws And Sources
ERISA Section 714, 29 U.S.C. 1185c: The statute itself: definitions, the one-year rule, physician certification, notice and changed coverage.
Public Health Service Act Section 2728, 42 U.S.C. 300gg-28: The same rule as it applies to health insurance issuers and group health plans under the PHSA.
Internal Revenue Code Section 9813, 26 U.S.C. 9813: The matching Code provision, with the Public Law 110-381 effective-date note.
DOL elaws Health Benefits Advisor for Employers, Michelle’s Law: Department of Labor plain-language questions on the continued-coverage rule and the notice requirement.
Public Health Service Act Section 2714, 42 U.S.C. 300gg-14: Dependent coverage of adult children until age 26.
29 CFR 2590.715-2714: The regulation barring limits based on student status for a child under age 26.
ERISA Section 102, 29 U.S.C. 1022: What a summary plan description must contain and how plainly it must be written.
MCL 500.2264a, Michigan Insurance Code: The Michigan rule on continued coverage for dependent students who leave school because of illness or injury.
Quick Answers.
Short replies on this page’s topic, each tied to a fuller guide.
What is Michelle’s Law?
A federal rule in ERISA section 714 (29 U.S.C. 1185c). A group health plan or insurer may not end a covered dependent student’s coverage because of a medically necessary leave of absence from school before the earlier of one year after the leave begins or the date coverage would otherwise end.
Does Michelle’s Law still matter now that children can stay on until age 26?
Yes, in some plans. DOL notes that federal law generally requires dependent coverage to age 26, but that Michelle’s Law may still apply, for example when a plan covers dependents beyond age 26 based on student status.
How long must coverage continue during a medical leave?
Until the earlier of one year after the first day of the leave or the date coverage would otherwise end under the plan terms.
Does the plan need a doctor’s certification?
The protection applies when the plan or insurer has received written certification from a treating physician that the child has a serious illness or injury and that the leave is medically necessary.
Does Michigan have its own rule on dependent students on medical leave?
Yes. MCL 500.2264a requires insurers to continue coverage for a dependent student who leaves school because of illness or injury, for 12 months from the last day of attendance or until the age coverage would otherwise end, whichever is shorter. It applies to policies delivered, issued or renewed in Michigan.
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