Michelle’s Law and Notice Requirements

Michelle Morse was diagnosed with colon cancer on December 12, 2003. She was a college student at Plymouth State University in New Hampshire when she found out about the diagnosis. Michelle had health insurance coverage through her mother’s employer-sponsored plan, a plan that required her to be a full-time student to qualify for coverage. If Michelle took time off from school to treat her cancer, she would lose her dependent eligibility status and would have to elect COBRA coverage at a significantly higher premium. As a result, Michelle continued to be enrolled as a full-time student while receiving chemotherapy and other treatments.

Sadly, Michelle lost her battle with cancer on November 10, 2005, but her family to continued to fight for her. Michelle’s family believed that no student should have to pay expensive premiums for COBRA or risk losing eligibility for coverage while dealing with a life-threatening illness. In 2006, the state of New Hampshire passed a law to help students in similar situations as Michelle. In 2008, Congress passed a similar federal law, a law which is known as Michelle’s Law.

In general, Michelle’s Law requires employer-sponsored plans (whether fully-insured or self-insured) to allow college students to take a medically necessary leave of absence from school for up 12 months. During the leave of absence, the employer sponsored plan must continue to treat the dependent as if they were a full-time student, and regular premiums (including employer contributions) must continue to apply.

Additionally, Michelle’s Law requires employer-sponsored plans to provide a written notice to employees if student status verification is needed for eligibility of coverage. The notice must include details about the 12-month leave of absence.

Some things have significantly changed since Michelle’s Law was passed. In particular, the Affordable Care Act (ACA) was signed into law. The ACA, among other things, now requires health plans to extend coverage to dependent children up to age 26, regardless of student status.

This means employers cannot base dependent eligibility for coverage on student status, unless the employer-sponsored plan allows coverage for dependents beyond age 26 and bases eligibility for such dependent coverage on student status.

The written notice requirements of Michelle’s Law no longer apply to employer-sponsored plans that only allow for dependent coverage up to age 26, however, those employer-sponsored plans that extend coverage to dependents beyond age 26 will need to continue to comply with Michelle’s Law notice requirements if eligibility for coverage requires the dependent to be a full-time student.

For more information on Michelle’s Law, click here.