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Michelle's Law Takes Effect October 9, 2009
Sep 04, 2009
Coverage changes take effect October 9
House Bill 2851 (HR 2851), otherwise known as Michelle's Law, is a federal law that requires health plans and issuers of health insurance coverage to continue coverage for college students who are forced to take a leave of absence or change their enrollment status due to a serious illness or injury. This law applies to fully insured and self-funded (ERISA and non-ERISA) Group and Individual medical, pharmacy, behavioral health and, when part of the health plan, dental and vision coverage.
The requirements of the new law are effective October 9, 2009
, and apply to all policies that are issued or renewed on or after that date. The following is a list of requirements:
- A dependent child who is eligible for continued coverage under Michelle's Law is entitled to the same level of benefits during a medically necessary leave of absence as would be available to the child if he/she had not taken a leave of absence.
- Additionally, if the child experiences a change in coverage during the leave of absence, the child remains eligible for continued coverage under the changed plan to the same extent that he/she would have been eligible for continued coverage under the prior plan, so long as the changed plan continues to provide coverage for dependent children as beneficiaries.
The coverage must be continued until the earlier of:
Comparison to State Law
- the date that is one year after the first day of the medically necessary leave of absence (or change in enrollment); or
- the date on which such coverage would otherwise terminate under the terms of the plan or health insurance coverage. For instance, if a dependent child on medical leave attains the maximum dependent age under the terms of the group health plan, their coverage will terminate.
- This law is similar to a New Hampshire law which was enacted by the New Hampshire Legislature in 2006. The New Hampshire law was named after Michelle Morse, a college student who had to continue her studies on a full-time basis after being diagnosed with cancer in order to avoid losing health coverage under her parents' plan.
- Since 2006, several other states have adopted their own versions of Michelle's Law, including California, Maine, Vermont, Virginia and Wisconsin. New York has a similar law, which was enacted in 1999.
- States are entitled to enact more demanding laws, to the extent that they are not inconsistent with HR 2851. State laws generally apply to fully insured plans and, possibly self-funded non-ERISA plans. Self-funded ERISA plans will only be subject to the federal Michelle's Law.
HR 2851 applies only when the dependent is eligible under the terms of the plan or health insurance coverage by virtue of his or her student status. It will not have an impact on state laws that generally require coverage for all dependents through a specified age regardless of student status.
The parent company of Anthem Blue Cross formed an enterprise project team dedicated to compliance with Michelle's Law. In the upcoming months, the project team will make necessary changes to operations, enrollment and billing processes, re-certification forms and booklet language. They will provide updates as they become available.
For additional details on Michelle's Law, refer to the Frequently Asked Questions
. An article communicating details of this regulatory change will be published in the Fall Employer newsletter. If you have questions related to these changes, please contact
your B&P Sales Representative.