42 U.S.C. § 300gg–28 — Coverage of dependent students on medically necessary leave of absence

(a) Medically necessary leave of absence. This term means a dependent child (described in (b)(2)) takes a leave of absence, or otherwise changes their enrollment, at a postsecondary school — including any institution that counts as an "institution of higher education" under a separate federal law. This counts only if: (1) the leave starts while the child has a serious illness or injury; (2) the leave is medically necessary; and (3) the leave causes the child to lose their status as a student for coverage purposes. (b) Requirement to continue coverage. (1) In general. If a dependent child described in paragraph (2) takes this kind of leave, the group health plan or individual health insurer can't end the child's coverage before the earlier of: one year after the leave starts, or whenever the coverage would have ended anyway under the plan's normal terms. (2) Dependent child described. This rule covers a child who (A) counts as a dependent child of a plan participant or beneficiary under the plan's terms, and (B) was enrolled in the plan as a student at a postsecondary school immediately before the leave started. (3) Certification by physician. The plan only has to keep covering the child if it has received a written certification from the child's treating physician, stating that the child has a serious illness or injury and that the leave (or other enrollment change) is medically necessary. (c) Notice. Whenever a plan sends a notice about needing to certify student status for coverage, it must also include a description of these leave-of-absence continuation rules — written in language a typical plan member can understand. (d) No change in benefits. While on a medically necessary leave, the child gets exactly the same benefits as if they were still a covered student at the school and not on leave. (e) Continued application in case of changed coverage. Suppose a child is partway through a covered leave period, and then the way the participant or beneficiary is covered changes — for example, the employer switches insurers, switches from insured to self-funded coverage, or makes some other change — and the new coverage still covers dependent children. In that case, this section keeps applying to the child under the new coverage for the rest of the original leave period, in the same way it would have applied under the old coverage.