AETNA PPO PLAN - My Benefits Portfolio - Trinity Health

CONTINUATION OF COVERAGE FOR ILL STUDENTS: MICHELLE’S LAW
Effective January 1, 2010, the Employee Retirement Income Security Act of 1974 (ERISA) includes
Michelle’s Law. To the extent Michelle’s Law is still applicable after the enactment of the Patient
Protection and Affordable Care Act (PPACA) and its implementing regulations, the Plan will not terminate
your covered Dependent child’s coverage if he or she cannot maintain a full-time course load due to a
Medically Necessary leave of absence from school (or a reduction in his or her school hours to part-time
student status for a Medically Necessary reason). A Dependent child is defined as a student enrolled in
post-secondary education before the Medically Necessary leave of absence.
The child will continue to be a Dependent for one year after the first day of any verified Medically
Necessary leave of absence or, if earlier, the date coverage would otherwise terminate under the Plan
because the child does not satisfy the other eligibility requirements for Dependent coverage (e.g.,
because the child attains age 26).
QUALIFIED MEDICAL CHILD SUPPORT ORDERS
The Plan will also provide coverage as required by the terms of a Qualified Medical Child Support Order
(“QMCSO”). This coverage applies even if you do not have legal custody of the child; the child is not
dependent on you for support, and regardless of any enrollment restrictions that may otherwise exist for
Dependent coverage. If the Plan Administrator receives a valid QMCSO and you do not enroll the
Dependent child, the custodial parent or state agency may enroll the affected child. Additionally, the
Employer may withhold from your paycheck any contributions required for such coverage.
A QMCSO is a court order or court-approved settlement agreement that provides for health benefits for a
child of a group health plan participant or enforces one of the mandatory provisions of state law regarding
the provision of health insurance to minors in such cases. A QMCSO gives the child the same rights as
an Associate to receive benefits under a group health plan.
A QMCSO may be either a National Medical Child Support Notice issued by a state child support agency
or an order or a judgment from a state court or administrative body directing the Employer to cover a child
under the Plan. Federal law provides that a QMCSO must meet certain form and content requirements to
be valid. The Plan Administrator follows certain procedures to determine if a child support notice is
“qualified.” You may receive a copy of these procedures at no charge. If you have any questions, or
would like a copy of the child support order qualification procedures, please contact the Plan
Administrator.
WHO’S NOT ELIGIBLE
• Your common law spouse;
• Your legal spouse and/or child(ren) if covered under the Plan or other group health plan offered by
Trinity Health as an Associate or Dependent;
• Any individual who begins active service in the armed forces of any country, unless coverage is
continued as provided under the Uniformed Services Employment and Reemployment Rights Act of
1994 (“USERRA”); and
• Any individual who does not meet the definition of a benefits-eligible Associate or an eligible
Dependent as described in this Eligibility section of this SPD.
If you are ineligible for coverage, your spouse and your other Dependents are not eligible for coverage.
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