110 HR 2851 IH: Michelle's U.S. House of Representatives 2007-06-25 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I 110th CONGRESS 1st Session H. R. 2851 IN THE HOUSE OF REPRESENTATIVES June 25, 2007 Mr. Hodes (for himself, Mr. Castle, Ms. Shea-Porter, Mr. Nadler, Mrs. McCarthy of New York, Mr. Davis of Illinois, Ms. Sutton, Mrs. Boyda of Kansas, Mr. McGovern, Mr. Stark, Ms. Castor, Ms. Clarke, Mr. Cohen, Mr. Johnson of Georgia, Mrs. Lowey, Mr. Edwards, Mr. Emanuel, Ms. Solis, Ms. Zoe Lofgren of California, Mr. Lantos, Mr. Sherman, Mr. Wu, Mr. Lincoln Davis of Tennessee, Mr. Kagen, Mr. Larson of Connecticut, Mr. Berry, Mr. McDermott, Mrs. Tauscher, Ms. Harman, Mr. Gutierrez, Mr. Scott of Virginia, Ms. Schakowsky, Mr. Mitchell, Mr. Sarbanes, Ms. Kaptur, Mr. Gilchrest, Mr. Barrow, Mr. McNulty, Mr. Welch of Vermont, Ms. Schwartz, Mr. Braley of Iowa, Mr. Ellison, Mr. Regula, and Mr. Bishop of New York) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Labor and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to ensure that dependent students who take a medically necessary leave of absence do not lose health insurance coverage, and for other purposes.

1.

Short title

This Act may be cited as the Michelle's Law.

2.

Coverage of dependent students on medically necessary leave of absence

(a)

Amendments of ERISA

(1)

In general

Subpart B of part 7 of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following:

714.

Coverage of dependent students on medically necessary leave of absence

(a)

Medically necessary leave of absence

In this section, the term medically necessary leave of absence means, with respect to a dependent child described in subsection (b)(2), a leave of absence of such child from a postsecondary educational institution (including an institution of higher education as defined in section 102 of the Higher Education Act of 1965), or any other change in enrollment of such child at such an institution, that— (1)commences while such child is suffering from a severe illness or injury; (2)is medically necessary; and (3)causes such child to lose full-time student status under the terms of the plan. (b)

Requirement To continue coverage

(1)

In general

In the case of a dependent child described in paragraph (2), a group health plan (or health insurance coverage offered in connection with such a plan) shall not terminate coverage of such child due to a medically necessary leave of absence before the date that is the earlier of— (A)the date that is 1 year after the first day of the medically necessary leave of absence; or (B)the date on which such coverage would otherwise terminate under the terms of the plan. (2)

Dependent child described

A dependent child described in this paragraph is a beneficiary under the plan who— (A)is a dependent child, under the terms of the plan, of a participant or beneficiary of the plan; (B)was enrolled in the plan or coverage as of the first day of the medically necessary leave of absence involved; and (C)was enrolled as a full-time student at a postsecondary educational institution (as described in subsection (a)) until the first day of the medically necessary leave of absence involved. (3)

Certification by physician

Paragraph (1) shall not apply to a group health plan (or health insurance coverage offered in connection with such a plan) unless certification by the child's attending physician is submitted to the plan or issuer stating that the dependent child is suffering from a severe illness or injury and that the leave of absence is medically necessary. (c)

No loss of full-time status due to break in semester

Any breaks in the school semester shall not disqualify a dependent child described under subsection (b) from coverage under this section. (d)

No change in benefits

A dependent child whose benefits are continued under this section shall be entitled to the same benefits as if (during the medically necessary leave of absence) the child continued to be a full-time student at the institution of higher education and was not on a medically necessary leave of absence. (e)

Coverage under successor plan

If a plan sponsor changes group health plans after the first day of a medically necessary leave of absence of dependent child described in subsection (b) but before the date described under subsection (b)(1), and such new group health plan offers coverage of beneficiaries as dependent children, such new group health plan shall be subject to this section in the same manner as the predecessor group health plan. (f)

Presumption

For purposes of administrative or judicial proceedings, upon certification under subsection (b)(3), there shall be a rebuttable presumption that the requirements of paragraphs (1) and (2) of subsection (a) have been met.

. (2)

Conforming amendment

The table of contents in section 1 of such Act is amended by inserting after the item relating to section 713 the following new item: Sec. 714. Coverage of dependent students on medically necessary leave of absence. . (b)

Amendments to the Public Health Service Act

(1)

Group markets

Subpart 2 of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–4 et seq.) is amended by adding at the end the following new section:

2707.

Coverage of dependent students on medically necessary leave of absence

(a)

Medically necessary leave of absence

In this section, the term medically necessary leave of absence means, with respect to a dependent child, a leave of absence of such child from a postsecondary educational institution (including an institution of higher education as defined in section 102 of the Higher Education Act of 1965), or any other change in enrollment of such child at such an institution, that— (1)commences while such child is suffering from a severe illness or injury; (2)is medically necessary; and (3)causes such child to lose full-time student status under the terms of the plan. (b)

Requirement To continue coverage

(1)

In general

In the case of a dependent child described in paragraph (2), a group health plan (or health insurance coverage offered in connection with such a plan) shall not terminate coverage of such child due to a medically necessary leave of absence before the date that is the earlier of— (A)the date that is 1 year after the first day of the medically necessary leave of absence; or (B)the date on which such coverage would otherwise terminate under the terms of the plan. (2)

Child described

A dependent child described in this paragraph is a beneficiary under the plan who— (A)is a dependent child, under the terms of the plan, of a participant or beneficiary of the plan; (B)was enrolled in the plan or coverage as of the first day of the medically necessary leave of absence involved; and (C)was enrolled as a full-time student at a postsecondary educational institution (as described in subsection (a)) until the first day of the medically necessary leave of absence involved. (3)

Certification by physician

Paragraph (1) shall not apply to a group health plan (or health insurance coverage offered in connection with such a plan) unless certification by the child's attending physician is submitted to the plan or issuer stating that the dependent child is suffering from a severe illness or injury and that the leave of absence is medically necessary. (c)

No loss of full-time status due to break in semester

Any breaks in the school semester shall not disqualify a dependent child described under subsection (b) from coverage under this section. (d)

No change in benefits

A dependent child whose benefits are continued under this section shall be entitled to the same benefits as if (during the medically necessary leave of absence) the child continued to be a full-time student at the institution of higher education and was not on a medically necessary leave of absence. (e)

Coverage under successor plan

If a plan sponsor changes group health plans after the first day of a medically necessary leave of absence of dependent child described in subsection (b) but before the date described under subsection (b)(1), and such new group health plan offers coverage of beneficiaries as dependent children, such new group health plan shall be subject to this section in the same manner as the predecessor group health plan. (f)

Presumption

For purposes of administrative or judicial proceedings, upon certification under subsection (b)(3), there shall be a rebuttable presumption that the requirements of paragraphs (1) and (2) of subsection (a) have been met.

. (2)

Individual market

Subpart 3 of part B of title XXVII of such Act (42 U.S.C. 300gg–51 et seq.) is amended by adding at the end the following new section:

2753.

Coverage of dependent students on medically necessary leave of absence

The provisions of section 2707 shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as they apply to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market.

. (c)

Amendments to the Internal Revenue Code

(1)

In general

Subchapter B of chapter 100 of the Internal Revenue Code of 1986 (relating to other group health plan requirements) is amended by inserting after section 9812 the following new section:

9813.

Coverage of dependent students on medically necessary leave of absence

(a)

Medically necessary leave of absence

In this section, the term medically necessary leave of absence means, with respect to a dependent child, a leave of absence of such child from a postsecondary educational institution (including an institution of higher education as defined in section 102 of the Higher Education Act of 1965), or any other change in enrollment of such child at such an institution, that— (1)commences while such child is suffering from a severe illness or injury; (2)is medically necessary; and (3)causes such child to lose full-time student status under the terms of the plan. (b)

Requirement To continue coverage

(1)

In general

In the case of a dependent child described in paragraph (2), a group health plan shall not terminate coverage of such child due to a medically necessary leave of absence before the date that is the earlier of— (A)the date that is 1 year after the first day of the medically necessary leave of absence; or (B)the date on which such coverage would otherwise terminate under the terms of the plan. (2)

Child described

A dependent child described in this paragraph is a beneficiary under the plan who— (A)is a dependent child, under the terms of the plan, of a participant or beneficiary of the plan; (B)was enrolled in the plan or coverage as of the first day of the medically necessary leave of absence involved; and (C)was enrolled as a full-time student at a postsecondary educational institution (as described in subsection (a)) until the first day of the medically necessary leave of absence involved. (3)

Certification by physician

Paragraph (1) shall not apply to a group health plan (or health insurance coverage offered in connection with such a plan) unless certification by the child's attending physician is submitted to the plan (or the issuer health insurance coverage in connection with the plan) stating that the dependent child is suffering from a severe illness or injury and that the leave of absence is medically necessary. (c)

No loss of full-time status due to break in semester

Any breaks in the school semester shall not disqualify a dependent child described under subsection (b) from coverage under this section. (d)

No change in benefits

A dependent child whose benefits are continued under this section shall be entitled to the same benefits as if (during the medically necessary leave of absence) the child continued to be a full-time student at the institution of higher education and was not on a medically necessary leave of absence. (e)

Coverage under successor plan

If a plan sponsor changes group health plans after the first day of a medically necessary leave of absence of a dependent child described in subsection (b) but before the date described under subsection (b)(1), and such new group health plan offers coverage of beneficiaries as dependent children, such new group health plan shall be subject to this section in the same manner as the predecessor group health plan. (f)

Presumption

For purposes of administrative or judicial proceedings, upon certification under subsection (b)(3), there shall be a rebuttable presumption that the requirements of paragraphs (1) and (2) of subsection (a) have been met.

. (2)

Conforming amendment

The table of sections for subchapter B of chapter 100 of such Code is amended by inserting after the item relating to section 9812 the following new item: Sec. 9813. Coverage of dependent students on medically necessary leave of absence. . (d)

Effective date

The amendments made by this Act shall apply with respect to plan years beginning on or after the date of the enactment of this Act and to medically necessary leaves of absence beginning during such plan years.