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§1185c Coverage of Dependent Students on Medically Necessary Leave of Absence

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

Last updated Sep 22, 2026|Official source

Summary

Group health plans must keep a dependent child’s coverage if the child takes a medically necessary leave from college. Medically necessary leave of absence means the student leaves or changes enrollment while having a serious illness or injury, the leave is needed for medical reasons, and the student loses student status for plan coverage. The plan cannot end the child’s coverage until the earlier of 1 year after the leave begins or the date the coverage would normally end. This rule applies only if the plan gets a written note from the child’s treating doctor saying the child has a serious illness or injury and the leave is medically necessary. Plans must include an easy-to-understand description of these rules when asking for proof of student status. The child must get the same benefits as if still a covered student. If the family’s coverage changes during the leave but the new coverage still covers dependent children, these protections continue for the rest of the leave.

Title 29, §1185c

Labor, Source: USLM XML via OLRC

(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 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)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)

(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 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 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 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 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,

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.

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.