‘‘(3) the coverage as so changed continues to 
provide coverage of beneficiaries as dependent chil-
dren, 
this section shall apply to coverage of the child under the 
changed coverage for the remainder of the period of the 
medically necessary leave of absence of the dependent 
child under the plan in the same manner as it would have 
applied if the changed coverage had been the previous cov-
erage.’’. 
(2) CONFORMING AMENDMENT.—The table of 
contents in section 1 of such Act is amended by in-
serting after the item relating to section 713 the fol-
lowing new item: 
‘‘Sec. 714. Coverage of dependent students on medically necessary leave of ab-
sence.’’. 
(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 ab-
sence’ means, with respect to a dependent child described
in subsection (b)(2) in connection with a group health plan 
or health insurance coverage offered in connection with 
such plan, a leave of absence of such child from a postsec-
ondary 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 or 
coverage. 
‘‘(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 de-
pendent child described in this paragraph is, with re-
spect to a group health plan or health insurance cov-
erage offered in connection with the plan, a bene-
ficiary under the plan who— 
‘‘(A) is a dependent child, under the terms 
of the plan or coverage, of a participant or ben-
eficiary under the plan or coverage; and 
‘‘(B) was enrolled in the plan or coverage, 
on the basis of being a student at a postsec-
ondary educational institution (as described in 
subsection (a)), immediately before the first day 
of the medically necessary leave of absence in-
volved. 
‘‘(3) CERTIFICATION
BY
PHYSICIAN.—Para-
graph (1) shall apply to a group health plan or 
health insurance coverage offered by an issuer in 
connection with such plan only if the plan or issuer 
of the coverage has received written certification by 
a treating physician of the dependent child which 
states that the child is suffering from a serious ill-
ness 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 in-
surance issuer providing health insurance coverage in con-
nection 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 descrip-
tion of the terms of this section for continued coverage 
during medically necessary leaves of absence. Such de-
scription 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) 
CONTINUED
APPLICATION
IN
CASE
OF 
CHANGED COVERAGE.—If— 
‘‘(1) a dependent child of a participant or bene-
ficiary is in a period of coverage under a group 
health plan or health insurance coverage offered in 
connection with such a plan, pursuant to a medically 
necessary leave of absence of the child described in 
subsection (b);
‘‘(2) the manner in which the participant or 
beneficiary is covered under the plan changes, 
whether through a change in health insurance cov-
erage or health insurance issuer, a change between 
health insurance coverage and self-insured coverage, 
or otherwise; and 
‘‘(3) the coverage as so changed continues to 
provide coverage of beneficiaries as dependent chil-
dren, 
this section shall apply to coverage of the child under the 
changed coverage for the remainder of the period of the 
medically necessary leave of absence of the dependent 
child under the plan in the same manner as it would have 
applied if the changed coverage had been the previous cov-
erage.’’. 
(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 ab-
sence’ 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 Edu-
cation 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 or 
coverage. 
‘‘(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 
under such plan 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 de-
pendent child described in this paragraph is, with re-
spect 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 
under the plan; and 
‘‘(B) was enrolled in the plan, on the basis 
of being a student at a postsecondary edu-
cational institution (as described in subsection
(a)), immediately before the first day of the 
medically necessary leave of absence involved. 
‘‘(3) CERTIFICATION
BY
PHYSICIAN.—Para-
graph (1) shall apply to a group health plan only if 
the plan, or the issuer of health insurance coverage 
offered in connection with the plan, has received 
written certification by a treating physician of the 
dependent child which states that the child is suf-
fering from a serious illness or injury and that the 
leave of absence (or other change of enrollment) de-
scribed in subsection (a) is medically necessary. 
‘‘(c) NOTICE.—A group health plan shall include, 
with any notice regarding a requirement for certification 
of student status for coverage under the plan, a descrip-
tion of the terms of this section for continued coverage 
during medically necessary leaves of absence. Such de-
scription 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) 
CONTINUED
APPLICATION
IN
CASE
OF 
CHANGED COVERAGE.—If— 
‘‘(1) a dependent child of a participant or bene-
ficiary is in a period of coverage under a group 
health plan, pursuant to a medically necessary leave 
of absence of the child described in subsection (b); 
‘‘(2) the manner in which the participant or 
beneficiary is covered under the plan changes, 
whether through a change in health insurance cov-
erage or health insurance issuer, a change between 
health insurance coverage and self-insured coverage, 
or otherwise; and 
‘‘(3) the coverage as so changed continues to 
provide coverage of beneficiaries as dependent chil-
dren, 
this section shall apply to coverage of the child under the 
changed coverage for the remainder of the period of the 
medically necessary leave of absence of the dependent 
child under the plan in the same manner as it would have 
applied if the changed coverage had been the previous cov-
erage.’’. 
(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 ab-
sence.’’. 
(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. 
Passed the House of Representatives July 30, 2008. 
Attest: 
Clerk.
110TH CONGRESS 
2D SESSION 
H. R. 2851 
AN ACT 
To amend the Employee Retirement Income Secu-
rity 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 in-
surance coverage, and for other purposes.