**MICHELLE'S LAW* EXPANDS HEALTH PLAN COVERAGE & NOTICE OBLIGATIONS FOR EMPLOYE

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**MICHELLE'S LAW** EXPANDS HEALTH PLAN COVERAGE AND NOTICE OBLIGATIONS FOR

EMPLOYERS

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July 7, 2009

 

By M. Brian Magargle

 

Columbia, SC

 

On October 9, 2009, an important new law affecting employer-sponsored

group health plans will become effective. The new law is known as **Michelle's

Law** (Pub. L. No.110-381) and expands employers* coverage and notice

obligations for eligible college students. You should begin preparing now to

meet these obligations.

 

Why Was This Law Enacted?

 

The law is named after a New Hampshire student, Michelle Morse, who was

diagnosed with colon cancer while she was in college. Although Michelle had

health coverage through her mother's employer-sponsored group plan, that

coverage required Michelle to be a full-time student with a full course load

to qualify for dependent coverage. If Michelle took time away from school to

fight her cancer, she would be dropped from dependent coverage and would

have to elect significantly more expensive COBRA coverage. As a result,

Michelle remained enrolled as a full-time student while receiving chemotherapy

and other treatments. However, Michelle*s family believed that no student

should have to face the financial hardship of COBRA premiums, or losing

health coverage altogether, while trying to deal with a life-threatening

disease.

 

Michelle lost her fight with cancer in November 2005. The following year,

New Hampshire passed a state law to lessen the burden on families like

Michelle's. In 2008, Congress passed a similar federal law that will affect

employer-sponsored group health plans throughout the United States, beginning

in October of this year.

 

What Does the Law Require?

 

What Does the Law Require? All group health plans must allow a college

student with a **serious illness or injury** to remain eligible for active

dependent coverage for 12 months, even if he or she no longer qualifies as a

full-time student. The law applies to both insured and self-insured health

plans, and the only exception is for certain state or local

government-sponsored self-insured arrangements, which may elect to opt out of

its

requirements. The specific requirements are ----

 

-- The individual must be covered as a full-time student, as defined in

the plan, at a postsecondary educational institution immediately before any

serious illness or injury occurs.

 

-- The student must experience a **serious illness or injury** that

requires a medically necessary leave of absence or a medically necessary change

in enrollment status from full-time to part-time. The term “serious illness

or injury†is not defined.

 

-- A physician must verify the illness or injury in writing and certify

the leave of absence or change in enrollment status as medically necessary.

The law does not contain a deadline by which this information must be

provided.

 

-- The health plan must allow the student to remain covered as an active

participant/dependent for 12 months after the leave of absence begins. The

regular premium will apply during these 12 months.

 

-- The 12 months, however, does not extend coverage beyond another

independent event that would end active/dependent status, such as the parent’s

termination of employment or the student exceeding the plan’s age limit.

 

-- COBRA coverage would not be offered until after the 12-month special

period has expired, unless the student returns to full-time status and remains

eligible under other terms of the plan.

 

Are There Any New Notice or Disclosure Requirements?

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