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Michelle’s Law
Overview:
Michelle’s Law, a new law signed into effect by
President Bush on November 8, 2008, extends eligibility for group
and individual health benefit plan coverage to a dependant child
over the age of 18 who is enrolled in an institution of higher education,
but would otherwise lose coverage under the group plan when a medical
leave of absence causes the dependant child to fall below the full-time
student status. The medical leave is valid for up to 12 months.
When does it go into effect?
Michelle’s Law is effective for new plans beginning
or existing plans renewing on or after October 9, 2009.
To whom does it apply?
It applies to both large and small group and individual
health plans including self-funded, fully insured, church plans
and governmental plans. The new law only impacts individual benefit
plans or employer groups that offer dependant coverage for full-time
students who would have otherwise reached the limiting age for eligibility.
What is required?
- Employers may not terminate a dependant child from a group
health plan as a result of the child taking a medically necessary
leave of absence from school or a change in enrollment status
(i.e. full-time to part-time) resulting from a medically necessary
leave of absence.
- To qualify for this benefit, the dependant child must qualify
for coverage on the basis that he/she is a student at an institution
of higher education before the first day of medical leave.
- The plan must receive certification from the treating physician
stating that because of an illness or injury that a leave of
absence is medically necessary.
- The coverage provided during the leave of absence time must
be the same coverage as if the leave of absence had not occurred.
If the benefits under the plan change during the extension,
those benefits would be available to the child.
How do members access this benefit extension?
- Members must notify their employer and the medical plan.
A status change form should be forwarded to the medical plan
along with a copy of the physician’s certification and the anticipated
length of leave.
- Treating physician or provider must provide in writing the
need for a medical leave of absence.
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