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Michelle’s Law

On October 9, 2008, President Bush signed into law "Michelle's Law." Michelle's Law is a very short law that did not provide a lot of guidance to plan administrators on how to administer this law. We hope additional guidance will be issued before plans must comply. 

To whom does Michelle's Law apply?
Applies to both large and small group health plans, including self-funded, fully insured and governmental plans.

What does Michelle's Law require?
Employers are prohibited from terminating a covered dependent child (as defined by the terms of the plan document), who is enrolled in a post-secondary educational institution, from the health plan if the covered dependent child takes a "medically necessary leave of absence" from the school or if the student reduces student hours due to a serious illness or injury that is medically necessary.

Employers must continue plan coverage for the dependent child upon written certification by the dependent's treating physician that states the dependent is suffering from a serious illness or injury and that a leave of absence (or reduction in student hours) is medically necessary until the earlier of: 

  • One year after the first day of the medically necessary leave of absence; or
  • The date on which the coverage under the plan would otherwise terminate.

In the event that any dependent child is covered under the above circumstances and the dependent child has a change in their health coverage that results in a loss of plan coverage under one plan, but new coverage is provided under another plan, the new plan must honor the remaining period of leave. For example, if a covered dependent has been on a medically necessary leave of absence for six months, and the individual's health coverage changes from Insurer A to Insurer B, the dependent child will still be eligible for the remaining six months of leave under Insurer B. 

In addition to the above requirements, plans are required to include with any notice that requires certification of student status, a description regarding the dependent's right to continue plan coverage under the terms of Michelle's Law.

When does Michelle's Law go into effect?
On first day of the plan year beginning one year after the date the Act was enacted (October 9, 2008), which means January 1, 2010 for calendar year plans.

See table below to determine when your plan must comply: 

First day of the plan yearDate you must comply byFirst day of the plan yearDate you must comply by
November 111/1/09May 15/1/10
December 112/1/09June 16/1/10
January 11/1/10July 17/1/10
February 12/1/10August 18/1/10
March 13/1/10September 19/1/10
April 14/1/10October 110/1/10

 

 

 

 

How does Michelle's Law impact employers?
Plan documents/SPDs are going to have to be amended, as well as other materials (i.e., full-time student forms, Healthy Balance Kits), to include a description of the dependent's right to continue plan coverage if withdrawal or reduction in student hours from a post-secondary education institution is due to a serious illness or injury that is medically necessary. Since most plans already contain a provision that allows disabled dependents to continue coverage under their Plan, those provisions are going to have to be looked at on a case by case basis to ensure full compliance. For example, there are a number of groups that require that in order for coverage to continue under the disabled child provision, the disability must have occurred prior to turning age 19. Provisions such as this will no longer be allowed if the Plan allows dependents to continue plan coverage as a dependent if enrolled in a post-secondary educational institution. 

Compliance Quarterly is being provided as an informational tool. It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan. By providing this publication and any attachments, Meritain Health is not exercising discretionary authority over the plan and is not assuming a plan fiduciary role, nor is Meritain Health providing legal advice.