A student on medical leave can keep dependent coverage for up to a year.
Michelle’s Law protects a dependent child who loses student status because of a medically necessary leave. This checklist covers the coverage rule, the doctor’s certification and the notice.
The Student Leave Checklist.
General information, not legal or tax advice. Check the cited sources before you act.
- Identify the child. The protection applies to a dependent child under the plan who was enrolled on the basis of being a student immediately before the leave began. 1185c(b)(2).
- Identify the leave. The leave from a postsecondary institution, or other change in enrollment there, must begin while the child has a serious illness or injury, must be medically necessary and must cause the child to lose student status under the plan terms. 1185c(a).
- Hold the coverage. The plan may not end the child’s coverage because of the leave before the earlier of one year after the first day of the leave or the date coverage would otherwise end under the plan. 1185c(b)(1).
- Get the certification. Protection applies only if the plan has received written certification from a treating physician that the child has a serious illness or injury and that the leave is medically necessary. 1185c(b)(3).
- Keep the benefits the same. The child receives the same benefits as if still enrolled and not on leave. 1185c(d).
- Follow plan changes. If coverage changes during the leave but still covers dependent children, the rule applies to the new coverage for the rest of the leave. 1185c(e).
What To Find In The Documents.
The notice item sits inside another notice. Under section 714(c), a plan that sends any notice about the certification requirement for student status must include a description of the continued coverage terms, in language the typical participant can understand. So find the plan’s dependent eligibility section and any student certification letter or form, and check that each carries the description.
Also check the plan’s definition of a dependent student. If it ends coverage at the moment of withdrawal from classes, the plan terms and the statute are in conflict for a child on qualifying leave.
Who To Contact.
Ask the carrier or administrator for the student certification form and letter, and confirm how a physician’s certification is logged and where the leave start date is recorded. Ask your enrollment system vendor how dependent student status is tracked and ended. Take questions about a particular leave to ERISA counsel. We can review the letter and form wording with you.
Related Rules And Tools.
Michelle’s Law and Dependent Student Coverage
Our full guide to the student leave rule.
Michigan Employer COBRA Guide
What happens when dependent coverage does end.
A Compliance Calendar for Your Plan Year
A plan-year view of the dates that matter.
Laws And Sources
29 U.S.C. 1185c (ERISA 714): Coverage of dependent students on medically necessary leave of absence.
29 U.S.C. 1191a (ERISA 732): Exceptions for small plans and excepted benefits.
General information, not legal or tax advice.
Quick Answers.
Brief answers on coverage for students on medically necessary leave.
How long does the coverage last?
Until the earlier of one year after the first day of the leave or the date coverage would otherwise end under the plan terms. See 29 U.S.C. 1185c(b)(1).
Does the plan need a doctor’s note?
Yes. The protection applies only if the plan has received written certification from a treating physician that the child has a serious illness or injury and the leave is medically necessary.
Do benefits change during the leave?
No. Under 29 U.S.C. 1185c(d), the child receives the same benefits as if still enrolled and not on leave.
The Rest Of This Series.
ERISA Part 7 Checklist Overview
The whole checklist and the notice and plan document table in one place.
Special Enrollment and Health Factor Rules Checklist
The enrollment windows and the health status ban.
Newborns’ Act 48 and 96 Hour Stay Checklist
The hospital stay floors for childbirth.
Women’s Health and Cancer Rights Act Checklist
Mastectomy reconstruction coverage and notice.
GINA Group Health Plan Checklist
Genetic tests and genetic information.
Mental Health Parity Checklist for Plan Sponsors
A short parity checklist with links to the full guides.
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