Michelle's Law
PL 110-381 (H.R.2851), enacted 10/09/2008

122 STAT. 4081 
PUBLIC LAW 110–381—OCT. 9, 2008 
Public Law 110–381 
110th Congress 
An Act 
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. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as ‘‘Michelle’s Law’’. 
SEC. 2. COVERAGE OF DEPENDENT STUDENTS ON MEDICALLY NEC-
ESSARY 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 NEC-
ESSARY LEAVE OF ABSENCE. 
‘‘(a) MEDICALLY NECESSARY LEAVE OF ABSENCE.—In this sec-
tion, the term ‘medically necessary leave of absence’ means, with 
respect to a dependent child described in subsection (b)(2) in connec-
tion with a group health plan or health insurance coverage offered 
in connection with such plan, a leave of absence of such child 
from a postsecondary educational institution (including an institu-
tion 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 cov-
erage of such child under such plan or health insurance cov-
erage 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 
29 USC 1185c. 
42 USC 201 note. 
Michelle’s Law. 
Oct. 9, 2008 
[H.R. 2851] 
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122 STAT. 4082 
PUBLIC LAW 110–381—OCT. 9, 2008 
‘‘(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 or health insurance coverage offered in connection with 
the plan, a beneficiary under the plan who— 
‘‘(A) is a dependent child, under the terms of the plan 
or coverage, of a participant or beneficiary under the plan 
or coverage; and 
‘‘(B) was enrolled in the plan or coverage, on the basis 
of being a student at a postsecondary educational institu-
tion (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 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 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 bene-
fits 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
COV-
ERAGE.—If— 
‘‘(1) a dependent child of a participant or beneficiary 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 coverage 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 cov-
erage of beneficiaries as dependent children, 
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 coverage.’’. 
Applicability. 
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122 STAT. 4083 
PUBLIC LAW 110–381—OCT. 9, 2008 
(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 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 sec-
tion, the term ‘medically necessary leave of absence’ means, with 
respect to a dependent child described in subsection (b)(2) in connec-
tion with a group health plan or health insurance coverage offered 
in connection with such plan, a leave of absence of such child 
from a postsecondary educational institution (including an institu-
tion 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 cov-
erage of such child under such plan or health insurance cov-
erage 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 or health insurance coverage offered in connection with 
the plan, a beneficiary under the plan who— 
‘‘(A) is a dependent child, under the terms of the plan 
or coverage, of a participant or beneficiary under the plan 
or coverage; and 
‘‘(B) was enrolled in the plan or coverage, on the basis 
of being a student at a postsecondary educational institu-
tion (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 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 illness or injury 
Applicability. 
42 USC 300gg–7. 
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122 STAT. 4084 
PUBLIC LAW 110–381—OCT. 9, 2008 
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 bene-
fits 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
COV-
ERAGE.—If— 
‘‘(1) a dependent child of a participant or beneficiary 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 coverage 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 cov-
erage of beneficiaries as dependent children, 
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 coverage.’’. 
(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 sec-
tion, the term ‘medically necessary leave of absence’ means, with 
respect to a dependent child described in subsection (b)(2) in connec-
tion with a group health plan, a leave of absence of such child 
26 USC 9813. 
Applicability. 
42 USC
300gg–54. 
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122 STAT. 4085 
PUBLIC LAW 110–381—OCT. 9, 2008 
from a postsecondary educational institution (including an institu-
tion 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 shall not termi-
nate 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 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 under the plan; and 
‘‘(B) was enrolled in 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 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 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 shall include, with any notice 
regarding a requirement for certification of student status for cov-
erage under the plan, 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 bene-
fits 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
COV-
ERAGE.—If— 
‘‘(1) a dependent child of a participant or beneficiary 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 coverage or health insurance issuer, a 
Applicability. 
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122 STAT. 4086 
PUBLIC LAW 110–381—OCT. 9, 2008 
LEGISLATIVE HISTORY—H.R. 2851: 
HOUSE REPORTS: No. 110–806, Pt. 1 (Comm. on Energy and Commerce). 
CONGRESSIONAL RECORD, Vol. 154 (2008): 
July 30, considered and passed House. 
Sept. 25, considered and passed Senate. 
change between health insurance coverage and self-insured 
coverage, or otherwise; and 
‘‘(3) the coverage as so changed continues to provide cov-
erage of beneficiaries as dependent children, 
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 coverage.’’. 
(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. 
Approved October 9, 2008. 
26 USC 9813 
note. 
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