§1185c — Title 29 Labor | U.S. Code

§1185c Coverage of dependent students on medically necessary leave of absence

Title 29 › Chapter CHAPTER 18— - EMPLOYEE RETIREMENT INCOME SECURITY PROGRAM › Subchapter SUBCHAPTER I— - PROTECTION OF EMPLOYEE BENEFIT RIGHTS › Subtitle Subtitle B— - Regulatory Provisions › Part part 7— - group health plan requirements › Subpart Subpart B— - Other Requirements › § 1185c

Last updated Apr 6, 2026|Official source

Summary

Group health plans and the insurers that sell coverage with them must keep a dependent student on the plan if the student takes a medically necessary leave from a college or other postsecondary school. Coverage can’t be ended earlier than the sooner of: the date 1 year after the leave begins, or the date the plan would have stopped coverage anyway. A medically necessary leave means the student leaves or changes enrollment because of a serious illness or injury, the leave is needed for medical reasons, and the student loses student status. A dependent child means someone the plan treats as a dependent who was enrolled as a student right before the leave. The plan or issuer must have a written note from the child’s treating doctor saying the child has a serious illness or injury and that the leave is medically necessary. Any notice about proving student status must explain these rules in plain, easy-to-understand language. While the child’s coverage continues under this rule, the child gets the same benefits as if still a student.

Title 29, §1185c

Labor — Source: USLM XML via OLRC

(a)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 or health insurance coverage offered in connection with such plan, a leave of absence of such child from a postsecondary educational institution (including an institution of higher education as defined in section 1002 of title 20), 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)(1)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)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 institution (as described in subsection (a)), immediately before the first day of the medically necessary leave of absence involved.

(3)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)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)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)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 coverage of beneficiaries as dependent children,

Notes & Related Subsidiaries

Statutory Notes and Related Subsidiaries

Effective Date

Section applicable with respect to plan years beginning on or after the date that is one year after Oct. 9, 2008, and to medically necessary leaves of absence beginning during such plan years, see section 2(d) of Pub. L. 110–381, set out as a note under section 9813 of Title 26, Internal Revenue Code.