On October 9 of this year a new federal law—called Michelle’s Law—regarding who’s entitled to health benefits will go into effect. The law is named for Michelle Morse, a New Hampshire college student with cancer who continued with a full course load against her doctor’s advice in order to maintain health benefits under her parents’ health plan. The parents’ employer-sponsored group health plan only covered dependent children who were enrolled in school on a full-time basis, and would have discontinued coverage if Michelle had taken a medical leave of absence from school in order to undergo treatment.
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Michelle’s Law, which will apply in California, requires all group health plans to continue health coverage of children of employees if:
- The child qualifies as a dependent under the plan’s terms, and;
- The child is enrolled in the plan on the basis of attending a postsecondary educational institution before the first day that the medically necessary leave is needed.
In addition, the child’s leave of absence must:
- commence while the child is suffering from serious illness or injury;
- Be medically necessary, as certified by the child’s treating physician, and;
- Cause the child to lose student status for purposes of coverage under the terms of the plan or coverage.
Health plans and insurers must provide notice of the right to continued coverage for medically necessary school leaves of absence, including instructions on what’s required to qualify for the coverage continuation, along with any notice that addresses certification of student status. This means that employers should amend plan documents, summary plan descriptions, and other employee communications to ensure notice of and compliance with the new law.