II 110th CONGRESS 1st Session S. 400 IN THE SENATE OF THE UNITED STATES January 25, 2007 Mr. Sununu (for himself, Mr. Gregg, and Mrs. Clinton) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend the Employee Retirement Income Security Act of 1974 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

Subpart A of part 7 of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181 et seq.) is amended by adding at the end the following:

704.

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 a leave of absence from a postsecondary educational institution (including an institution of higher education as defined in section 102 of the Higher Education Act of 1965) that— (1)is due to a severe illness or injury, as certified by the attending physician of the dependent child involved; and (2)causes the dependent child involved to lose full-time student status. (b)

Requirement To continue coverage

(1)

In general

In the case of a dependent child described under 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 child who— (A)is a dependent of a participant or beneficiary of the plan or coverage; (B)is 18 years of age or older; (C)was enrolled in the plan or coverage as of the first day of the medically necessary leave of absence involved; and (D)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 the dependent child submits to the plan or issuer and the postsecondary educational institution involved, documentation and certification by the child's attending physician stating that the leave of absence involved is a medically necessary leave of absence. (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 additional coverage

A dependent child described under subsection (b) shall be entitled to an extension under this section of only those benefits to which the child was entitled under the terms of the plan or coverage as of the first day of the medically necessary leave of absence involved. (e)

Coverage under successor plan

If an employer or health insurance issuer 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 dependent children, such new group health plan shall be subject to this section in the same manner as the group health plan coverage in effect on the first day of the medically necessary leave of absence of such dependent child. (f)

Presumption

For purposes of administrative or judicial proceedings, there shall be a rebuttable presumption that the documentation and certification under subsection (b)(3) entitles the dependent child involved to coverage as described under this section.

. (b)

Amendments to the Internal Revenue Code

Subchapter B of chapter 100 of the Internal Revenue Code of 1986 (26 U.S.C. 9811 et seq.) is amended— (1)in the table of sections, 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. ; and (2)by inserting after section 9813 the following:

9813.

Coverage of dependent students on medically necessary leave of absence

(a)

Medically necessary leave of absence

The term medically necessary leave of absence means a leave of absence from a postsecondary educational institution (including an institution of higher education as defined in section 102 of the Higher Education Act of 1965) that— (1)is due to a severe illness or injury, as certified by the attending physician of the dependent child involved; and (2)causes the dependent child involved to lose full-time student status. (b)

Requirement To continue coverage

(1)

In general

In the case of a dependent child described under 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 child who— (A)is a dependent of a participant or beneficiary of the plan or coverage; (B)is 18 years of age or older; (C)was enrolled in the plan or coverage as of the first day of the medically necessary leave of absence involved; and (D)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 the dependent child submits to the plan or issuer and the postsecondary educational institution involved, documentation and certification by the child's attending physician stating that the leave of absence involved is a medically necessary leave of absence. (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 additional coverage

A dependent child described under subsection (b) shall be entitled to an extension under this section of only those benefits to which the child was entitled under the terms of the plan or coverage as of the first day of the medically necessary leave of absence involved. (e)

Coverage under successor plan

If an employer or health insurance issuer 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 dependent children, such new group health plan shall be subject to this section in the same manner as the group health plan coverage in effect on the first day of the medically necessary leave of absence of such dependent child. (f)

Presumption

For purposes of administrative or judicial proceedings, there shall be a rebuttable presumption that the documentation and certification under subsection (b)(3) entitles the dependent child involved to coverage as described under this section.

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