H. Rept. 110-806 - MICHELLE'S LAW110th Congress (2007-2008)
Committee Report
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110th Congress Rept. 110-806
HOUSE OF REPRESENTATIVES
2d Session Part 1
======================================================================
MICHELLE'S LAW
_______
July 30, 2008.--Ordered to be printed
_______
Mr. Dingell, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 2851]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 2851) 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, having
considered the same, report favorably thereon with an amendment
and recommend that the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 5
Background and Need for Legislation.............................. 5
Hearings......................................................... 6
Committee Consideration.......................................... 6
Committee Votes.................................................. 6
Committee Oversight Findings..................................... 8
Statement of General Performance Goals and Objectives............ 8
New Budget Authority, Entitlement Authority, and Tax Expenditures 8
Earmarks and Tax and Tariff Benefits............................. 8
Committee Cost Estimate.......................................... 8
Congressional Budget Office Estimate............................. 8
Federal Mandates Statement....................................... 9
Advisory Committee Statement..................................... 10
Constitutional Authority Statement............................... 10
Applicability to Legislative Branch.............................. 10
Section-by-Section Analysis of the Legislation................... 10
Changes in Existing Law Made by the Bill, as Reported............ 12
Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as ``Michelle's Law''.
SEC. 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:
``SEC. 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:
``SEC. 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 described in subsection (b)(2) in connection with a
group health plan, 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 serious
illness or injury;
``(2) is medically necessary; and
``(3) causes such child to lose student status for purposes
of coverage 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 a health insurance
issuer that provides health insurance coverage in connection
with a group health plan) shall not terminate coverage of such
child under such plan or health insurance coverage 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 or health
insurance coverage.
``(2) Dependent child described.--A dependent child described
in this paragraph is, with respect to a group health plan, 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; and
``(B) was enrolled in the plan (or health insurance
coverage offered in connection with the plan), on the
basis of being a student at a postsecondary educational
institution (as described in subsection (a)),
immediately before the first day of the medically
necessary leave of absence involved.
``(3) Certification by physician.--Paragraph (1) shall apply
to a group health plan (or health insurance coverage offered by
an issuer in connection with a group health plan) only if the
plan or issuer has received written certification by a treating
physician of the dependent child which states that the child is
suffering from a serious illness or injury and that the leave
of absence (or other change of enrollment) described in
subsection (a) is medically necessary.
``(c) Notice.--A group health plan, and a health insurance issuer
providing health insurance coverage in connection with a group health
plan, shall include, with any notice regarding a requirement for
certification of student status for coverage under the plan or
coverage, a description of the terms of this section for continued
coverage during medically necessary leaves of absence. Such description
shall be in language which is understandable to the typical plan
participant.
``(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 covered 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.''.
(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:
``SEC. 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:
``SEC. 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 that is one year
after the date of the enactment of this Act and to medically necessary
leaves of absence beginning during such plan years.
Purpose and Summary
The purpose of H.R. 2851, Michelle's Law, is to ensure
continuity of health coverage for students, who because of a
serious illness or injury, can no longer maintain student
status.
Background and Need for Legislation
Michelle Morse was a full-time college student at Plymouth
State University in New Hampshire who was diagnosed with colon
cancer in 2003. Her doctors recommended that she cut back her
college course load while undergoing chemotherapy treatment.
She was informed, however, that if she cut back her classroom
hours, she would lose her health insurance coverage because she
would no longer qualify as a dependent on her parents' health
insurance plan.
Other health insurance coverage options were unaffordable.
As a result, she was forced to remain in school as a full-time
student while undergoing 14 rounds of chemotherapy. In 2005,
she succumbed to her illness. The case spurred interest in
protections that would extend the definition of dependents to
allow college students needing medical leaves of absence from
class work to retain health insurance coverage on their
parents' policies.
Private health insurance contracts define when a person can
be considered to be a ``dependent'' for the purpose of
purchasing a family health insurance plan. It is common
practice, although far from universal, that dependents are
considered to include college-age students as long as those
students are enrolled in college full-time. Many States also
have legislation that impacts how those dependents can be
defined. At least six States--Maine, New Hampshire, New York,
Vermont, Virginia, and Wisconsin--have enacted laws similar to
Michelle's Law. Those State laws extend the ability of
dependents to remain on their parents' plan for a limited
period of time during a medical leave from full-time student
status.\1\ Four States--Maryland, Michigan, Rhode Island, and
Texas--require insurers to allow college-age dependents who are
enrolled part-time in school to remain on their parent's health
insurance plan.\2\ At least nine additional States--Colorado,
Florida, Indiana, Massachusetts, Missouri, Montana, New Jersey,
New Mexico, and Utah--have enacted laws that would define
dependents to include those older than 18 (the exact age
varies) regardless of student status.\3\
---------------------------------------------------------------------------
\1\Based on a CRS review of State statutes and ``The Changing
Definition of `Dependent': Who is Insured and For How Long?''--National
Conference of State Legislatures, Updated February 2008.
\2\Based on a CRS review of State statutes and ``The Changing
Definition of `Dependent': Who is Insured and For How Long?''--National
Conference of State Legislatures, Updated February 2008.
\3\Based on a CRS review of State statutes and ``The Changing
Definition of `Dependent': Who is Insured and For How Long?''--National
Conference of State Legislatures, Updated February 2008.
---------------------------------------------------------------------------
States' laws, however, have limited applicability. States
can enact laws that apply to individually-offered health
insurance (not offered through employment) and to employment-
based coverage as long as it is coverage that is comprised of
an insurance product offered by companies in the business of
selling insurance (including health maintenance organizations.)
If an employer self-insures (funds and retains the risk
that the premiums collected may not cover the cost of medical
benefits provided) its employees, State laws regulating the
business of insurance do not apply. Over one-half of all
employees are covered by self-insured employment-based coverage
that is exempt from State insurance laws according to the
Department of Labor.\4\
---------------------------------------------------------------------------
\4\About 54 percent of workers were enrolled in employment-based
coverage that was self-insured in CY 2005. Unpublished Department of
Labor estimates based on March 2006 CPS.
---------------------------------------------------------------------------
Thus to protect individuals across all plan types, Federal
action is needed. H.R. 2851, or Michelle's Law, was introduced
in the House of Representatives by Representative Hodes. The
bill would extend the ability of dependents to remain on their
parents' plan for a limited period of time during a medical
leave from student status and would apply to all health
insurance products, whether sold to individuals or offered as a
workplace benefit, and whether or not the employer plan is
self-insured. More protective State laws would continue to
remain in effect. The bill does not disturb underlying Federal
protections relating to rights and responsibilities of plans,
issuers, or individuals. The American Cancer Society estimates
that this bill could impact about 2,400 college-age students
who will be diagnosed with cancer each year.
A similar bill, S. 400, was introduced in the Senate on
January 25, 2007, by Senators Sununu, Gregg, and Clinton. That
bill would have a more limited scope than H.R. 2851, however,
in that it would only apply to employer-provided health
insurance. It was referred to the Committee on Health,
Education, Labor, and Pensions. No further action has been
taken on S. 400.
Hearings
No hearings were held in connection with H.R. 2851 in the
Committee on Energy and Commerce.
Committee Consideration
On Wednesday, July 9, 2008, the Subcommittee on Health met
in open markup session and favorably forwarded H.R. 2851,
amended, to the full Committee for consideration, by a voice
vote. On Wednesday, July 16, 2008, the full Committee met in
open markup session and ordered H.R. 2851 favorably reported to
the House, amended, by a record vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto. A
motion by Mr. Dingell to order H.R. 2851 favorably reported to
the House, amended, was agreed to by a record vote of 40 yeas
and 0 nays, with two Members voting present. The following is
the recorded vote taken on the motion, including the names of
those Members voting for and against:
Committee Oversight Findings
Regarding clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the oversight findings of the
Committee regarding H.R. 2851 are reflected in this report.
Statement of General Performance Goals and Objectives
The purpose of H.R. 2851 is to ensure continuity of health
coverage for students, who because of a serious illness or
injury, can no longer maintain student status. The purpose is
to allow the student to continue coverage on their parents'
insurance plan for the duration of the plan year.
New Budget Authority, Entitlement Authority, and Tax Expenditures
Regarding compliance with clause 3(c)(2) of rule XIII of
the Rules of the House of Representatives, the Committee adopts
as its own the estimate of budget authority, entitlement
authority, revenues, and tax expenditures regarding H.R. 2851
prepared by the Director of the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974.
Earmarks and Tax and Tariff Benefits
Regarding compliance with clause 9 of rule XXI of the Rules
of the House of Representatives, H.R. 2851 does not contain any
congressional earmarks, limited tax benefits, or limited tariff
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
2851 prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate on
H.R. 2851 provided by the Congressional Budget Office pursuant
to section 402 of the Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, July 28, 2008.
Hon. John D. Dingell,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 2851, the
Michelle's Law.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Robert
Stewart.
Sincerely,
Robert A. Sunshine
(For Peter R. Orszag, Director).
Enclosure.
H.R. 2851--Michelle's Law
H.R. 2851 would require that group health plans continue to
provide coverage for full-time college students who take a
medically necessary leave of absence from school. Currently,
health plans extend coverage to dependents of family
policyholders as long as the dependent is either 18 or younger
or 22 or younger and enrolled at a post-secondary institution.
Dependents who are covered by the group health plan on the
basis of their enrollment at a post-secondary institution may
lose eligibility if they take a leave of absence for any
reason. H.R. 2851 would create an exception to that rule by
preventing group health plans from terminating coverage if the
leave of absence is for medical reasons.
CBO estimates that H.R. 2851 would have no significant
impact on the budget. It would have a negligible impact on
federal revenues. CBO assumes that less than one percent of
students go on medical leave of absence annually, of which
approximately half are covered as dependents under employer-
sponsored insurance. Furthermore, many states already require
employer-sponsored plans to cover dependents up to 22 years of
age and older for other reasons; students in these states would
not be affected by the proposed law. This leaves a very small
proportion of students enrolled in post-secondary educational
institutions to whom the bill would apply.
An insurer's cost of covering a college student who goes on
medical leave can be significant; for those taking medical
leaves of absence, the most common causes are mental disorders,
major illnesses such as cancer, drug and alcohol-related
problems, and serious trauma. However, due to the small number
of students who take medical leaves of absence and state
requirements that plans cover dependents above 22 years of age,
the overall cost to group health plans would be negligible.
H.R. 2851 would not impose an intergovernmental mandate but
would impose a private-sector mandate as defined in the
Unfunded Mandates Reform Act (UMRA). (The bill would marginally
affect the budgets of state and local governments only if they
chose to comply with the bill's requirements.) The bill would
impose a private-sector mandate by requiring group health plans
to continue the coverage of full-time students enrolled in a
post-secondary institution who take a medically necessary leave
of absence. CBO estimates that the costs of complying with the
mandate would be small and would not exceed the thresholds
established in UMRA ($136 million in 2008, adjusted annually
for inflation).
The CBO staff contacts for this estimate are Robert Stewart
(for federal costs) and Stuart Hagen (for the private-sector
impact). This estimate was approved by Keith J. Fontenot,
Deputy Assistant Director for Health and Human Resources,
Budget Analysis Division.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 2851 prepared by the Director of the
Congressional Budget Office pursuant to section 423 of the
Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
2851.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for H.R. 2851 is provided in Article
I, section 8, clause 3, which grants Congress the power to
regulate commerce with foreign nations, among the several
States, and with the Indian Tribes.
Applicability to Legislative Branch
The Committee finds that H.R. 2851 does not relate to the
terms and conditions of employment or access to public services
or accommodations within the meaning of section 102(b)(3) of
the Congressional Accountability Act of 1995.
Section-by-Section Analysis of the Legislation
Section 1. Short title
This section establishes the short title of the legislation
as ``Michelle's Law''.
Section 2. Coverage of dependent students on medically necessary leave
of absence
(a) Amendments of ERISA
This provision would add a new section to the Employee
Retirement Income Security Act of 1974 (ERISA) requiring all
employer-provided health insurance plans (whether insured or
self-insured) to continue coverage for a child dependent on a
medically necessary leave of absence for a period of up to one
year after the first day of the leave of absence or the date on
which such coverage would otherwise terminate under the terms
of the plan, whichever is earlier. Very small employer plans,
those with fewer than 2 participants, are exempted from this
requirement. A dependent child is described as a dependent
under the terms of the plan who was enrolled in the plan on the
first day of the medically necessary leave of absence and was
enrolled as a full-time student at a postsecondary education
institution until the first day of the medically necessary
leave of absence.
A medically necessary leave of absence is defined as a
leave of absence (or any other change in enrollment) from a
post secondary education institution that (1) begins while the
child is suffering from a severe illness or injury, (2) is
medically necessary, and (3) causes the child to lose full-time
student status under the terms of the plan. The bill would
require a certification by the child's attending physician be
submitted to the plan or issuer stating that the dependent is
suffering from a severe illness or injury and that the leave of
absence is medically necessary. .The bill provides that if the
child's attending physician has made this certification, for
purposes of an administrative or judicial proceeding there
shall be a rebuttable presumption that the child has met the
first two criteria for a medically necessary leave of absence.
The bill states that breaks in the school semester can not
disqualify a dependent from protection against disenrollment.
The bill states that benefits cannot be reduced during the
medically necessary leave of absence. Ordinary rights under
ERISA pertaining to items such as appeals, notice, denials, and
continuation of COBRA coverage would continue to apply.
(b) Amendments to the Public Health Service Act
Similar provisions are added to the Public Health Service
Act, ensuring applicability of the law to insurance carriers
and other entities in the business of selling health coverage
both to employers and to individuals. The provisions differ
from the ERISA provisions described above in the following
ways:
It clarifies that the protections of the
legislation apply to dependents who qualify under the plan as
students, not solely those who lose full-time student status.
This would not require plans to cover any particular class of
dependent, but only ensure that all classes of student
dependents covered under a plan would receive the protections
of the legislation. A plan would not be required to cover a
full time student as a dependent. Only that if the plan did
cover a full time student as a dependent than the provisions of
the bill apply. Similarly, the bill does not require a plan to
cover a part time student as a dependent.
It modifies the definition of medical leave to be
the result of a ``serious illness or injury'' instead of a
``severe illness or injury.''
It modifies the requirement to provide a physician
certification so that the child's ``treating'' physician must
provide such certification instead of the child's attending
physician.
It adds a requirement that insofar as plans
provide notice of the availability of coverage of dependent
students, the notice describes that such coverage remains
available during medical leave.
It removes provisions regarding intra-semester
breaks and the presumption relating to the burden of proof in
legal and administrative proceedings.
It ensures that certification by the treating
physician is sufficient proof of serious illness or injury and
the medical necessity of the student's leave of absence for the
protections of the bill to apply.
(c) Amendments to the Internal Revenue Code
Provisions identical to the ERISA amendments are added to
the Internal Revenue Code, ensuring the applicability of the
law to certain types of health coverage that is not employer
sponsored nor sold by entities in the business of selling
health insurance or health coverage; such as church-sponsored
plans. In addition, these provisions ensure that certain
penalties for non-compliance described in the Internal Revenue
Code are applicable for entities that are found to be in
violation of the provisions.
(d) Effective date
The bill would become effective for plan years beginning on
or after one year after the date of enactment.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (new matter is
printed in italic and existing law in which no change is
proposed is shown in roman):
EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974
Section 1. This Act may be cited as the ``Employee Retirement
Income Security Act of 1974''.
TABLE OF CONTENTS
Sec. 1. Short title and table of contents.
TITLE I--PROTECTION OF EMPLOYEE BENEFIT RIGHTS
* * * * * * *
Subtitle B--Regulatory Provisions
* * * * * * *
Part 7--Group Health Plan Requirements
* * * * * * *
Subpart B--Other Requirements
* * * * * * *
Sec. 714. Coverage of dependent students on medically necessary leave of
absence.
* * * * * * *
TITLE I--PROTECTION OF EMPLOYEE BENEFIT RIGHTS
* * * * * * *
Subtitle B--Regulatory Provisions
* * * * * * *
Part 7--Group Health Plan Requirements
* * * * * * *
Subpart B--Other Requirements
* * * * * * *
SEC. 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.
* * * * * * *
----------
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE XXVII--REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE
Part A--Group Market Reforms
* * * * * * *
Subpart 2--Other Requirements
* * * * * * *
SEC. 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 described in subsection (b)(2) in
connection with a group health plan, 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
serious illness or injury;
(2) is medically necessary; and
(3) causes such child to lose student status for
purposes of coverage 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 a
health insurance issuer that provides health insurance
coverage in connection with a group health plan) shall
not terminate coverage of such child under such plan or
health insurance coverage 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
or health insurance coverage.
(2) Dependent child described.--A dependent child
described in this paragraph is, with respect to a group
health plan, 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; and
(B) was enrolled in the plan (or health
insurance coverage offered in connection with
the plan), on the basis of being a student at a
postsecondary educational institution (as
described in subsection (a)), immediately
before the first day of the medically necessary
leave of absence involved.
(3) Certification by physician.--Paragraph (1) shall
apply to a group health plan (or health insurance
coverage offered by an issuer in connection with a
group health plan) only if the plan or issuer has
received written certification by a treating physician
of the dependent child which states that the child is
suffering from a serious illness or injury and that the
leave of absence (or other change of enrollment)
described in subsection (a) is medically necessary.
(c) Notice.--A group health plan, and a health insurance
issuer providing health insurance coverage in connection with a
group health plan, shall include, with any notice regarding a
requirement for certification of student status for coverage
under the plan or coverage, a description of the terms of this
section for continued coverage during medically necessary
leaves of absence. Such description shall be in language which
is understandable to the typical plan participant.
(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 covered 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.
* * * * * * *
Part B--Individual Market Rules
* * * * * * *
Subpart 3--General Provisions
* * * * * * *
SEC. 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.
* * * * * * *
----------
INTERNAL REVENUE CODE OF 1986
* * * * * * *
Subtitle K--Group Health Plan Requirements
* * * * * * *
CHAPTER 100--GROUP HEALTH PLAN REQUIREMENTS
* * * * * * *
Subchapter B--Other Requirements
* * * * * * *
Sec. 9813. Coverage of dependent students on medically necessary leave
of absence.
* * * * * * *
SEC. 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.
* * * * * * *