Medical Leave of Absence (MLOA) & Your F-1 Visa: A Guide for International Students

For an international student in the United States, getting sick is not just a health crisis—it is a legal one.

Domestic students who fall ill can simply take a semester off, go home to their parents, and return when they are ready. For F-1 visa holders, however, the rules are governed by the Department of Homeland Security (DHS) and strict immigration laws.

Your visa status is tied directly to your enrollment. The moment you stop attending classes, you technically violate the terms of your F-1 status. This creates a terrifying "double whammy": you are too sick to study, but if you stop studying, you risk deportation.

This guide is designed to navigate the complex intersection of Medical Leave of Absence (MLOA), Reduced Course Load (RCL), and health insurance gaps. It will help you understand how to prioritize your health without sacrificing your American education or your legal standing in the country.

Part 1: The "Full Course of Study" Rule

To understand why medical leave is so complicated, you must first understand the baseline requirement.

Under federal regulations (8 CFR 214.2(f)(6)), F-1 students must maintain a "Full Course of Study" during every academic term (fall and spring).
* Undergraduate: Usually 12 credit hours.
* Graduate: Usually 9 credit hours (depending on the university).

If you drop below this threshold without prior authorization from your Designated School Official (DSO), your SEVIS record will be terminated for "Unauthorized Drop Below Full Course." This effectively ends your legal stay in the US immediately.

So, what happens if a severe illness, surgery, or mental health crisis makes it impossible to finish your 12 credits? You have two main legal options.

Part 2: The First Line of Defense – Reduced Course Load (RCL)

Before you withdraw completely, you should consider a Reduced Course Load (RCL) for Medical Conditions. This allows you to stay in the US and keep your active F-1 status while taking fewer classes—or even zero classes—for a semester.

The Rules of Medical RCL

1. Authorization: You must obtain authorization from your DSO before you drop the classes. Never drop the class first and ask later.
2. Time Limit: You are allowed a maximum of 12 months of medical RCL per degree level. This can be taken all at once or split into different semesters.
3. Documentation: This is the most critical part. Your DSO cannot grant an RCL based on your word alone. You must provide a letter from a specific type of medical professional.

The Specific Documentation Requirement

Immigration regulations are very specific about who can write this note. The letter must come from:
* A licensed Medical Doctor (M.D.)
* A Doctor of Osteopathy (D.O.)
* A Licensed Clinical Psychologist

Crucial Warning: Notes from chiropractors, acupuncturists, nurse practitioners (in some strict interpretations), or generic counselors often do not meet the federal requirement for RCL.

The letter must explicitly recommend that you take a reduced course load due to a medical condition. It does not necessarily need to disclose the specific diagnosis to the DSO (privacy laws apply), but it must state the medical necessity of the reduction.

For a detailed walkthrough on how to navigate this process, read our guide: Navigating Reduced Course Load in the USA: A Comprehensive Guide for College Students.

Part 3: The Nuclear Option – Full Medical Leave of Absence

If your condition is severe enough that you cannot stay in the US, or if you have exhausted your 12 months of RCL, you may need to take a full Medical Leave of Absence (MLOA) and withdraw from the university temporarily.

The Procedure

1. Medical Withdrawal: You petition the university registrar for a medical withdrawal. This freezes your grades (often as "W" for Withdrawal) rather than failing them.
2. SEVIS Termination (Authorized Early Withdrawal): Your DSO will terminate your SEVIS record with a distinct reason: "Authorized Early Withdrawal." This is a "positive" termination. It tells the US government you didn't break the rules; you just went home.
3. Departure: You usually have 15 days to leave the United States after the withdrawal is processed. You generally cannot stay in the US to receive medical treatment unless you are hospitalized and physically unable to travel.

The "5-Month Rule"

If you are outside the United States for more than 5 months, your F-1 status effectively lapses.
* Returning: To return, you will likely need a new Form I-20, you may need to pay the SEVIS fee again, and in some cases, you may need to apply for a new F-1 visa stamp at a US embassy.
* CPT/OPT Reset: A major downside is that the "clock" for Curricular Practical Training (CPT) and Optional Practical Training (OPT) resets. You must be enrolled for one full academic year after you return before you are eligible for off-campus work authorization again.

For more on managing this transition and protecting your long-term status, check our resource: How International Students Can Obtain and Use Medical Certificates for Leave, Deferral, or Withdrawal.

Part 4: The Mental Health Trap

Mental health issues—depression, severe anxiety, bipolar disorder—are among the most common reasons for MLOA among international students. However, they are also the most dangerous for visa status because they are invisible.

The "Wait and See" Mistake:
Many students try to power through a depressive episode. They stop going to class, isolate themselves in their dorm, and fail their finals. Only after they receive a dismissal letter do they try to claim "medical reasons."

Retroactive medical withdrawals are extremely difficult to get. Universities and immigration officials are skeptical of students who claim medical illness only after seeing bad grades.

The Strategy:
If you are struggling with mental health, you must get documentation immediately. Even if you hope to finish the semester, having a dated medical certificate from the onset of your symptoms provides the "insurance" you need if you later have to apply for a retroactive withdrawal or an RCL.

We cover the specifics of using psychological documentation for gap years or leave in this guide: How International Students Can Use a Mental Health Certificate to Apply for a Gap Year or Leave of Absence.

Part 5: The Financial Crisis – Refunds and Insurance

Visa status is your first worry; money is your second. An MLOA can be financially devastating if not managed correctly.

Tuition Refunds

University refund policies are brutal. They typically follow a sliding scale:
* Week 1-2: 80-100% Refund.
* Week 3-4: 40-50% Refund.
* Week 5+: 0% Refund.

If you withdraw for medical reasons in Week 10, you have likely lost $30,000+ in tuition. Some universities have a "Tuition Insurance" appeal process where, with strong medical documentation, they may credit the tuition toward a future semester, but cash refunds are rare.

The Insurance Gap (Crucial!)

This is the trap that bankrupts families.
Most international students are on the university’s Student Health Insurance Plan (SHIP).
* The Rule: SHIP eligibility is tied to enrollment.
* The Consequence: If you withdraw from school on October 1st, your insurance coverage might terminate on October 1st (or at the end of that month).

If you stay in the US for a few days to pack up, or if you are hospitalized, you are now uninsured in the most expensive healthcare system in the world.

Recommendation: If you withdraw, immediately purchase "Short Term Medical Insurance" (like plan from ISO, PSI, or Atlas America) to cover the gap between your withdrawal date and the day your flight lands in your home country. Never be in the US without coverage for even one day.

Part 6: Step-by-Step Checklist for MLOA

If you must take leave, follow this order of operations to protect your F-1 status:

1. Seek Medical Care First: You cannot get leave without proof. You need a licensed doctor to verify your condition.
2. Meet with your DSO: Do not drop classes yet. Bring your medical evidence to the International Students Office.
3. Submit RCL Paperwork: Fill out the "Reduced Course Load" form. Wait for the DSO to approve it in SEVIS.
4. Withdraw from Classes: Only after the DSO gives the green light should you withdraw from the registrar.
5. Check Insurance: Confirm the exact date your school insurance expires. Buy bridge coverage if needed.
6. Depart (if required): If you are not on RCL and are doing a full withdrawal, leave the US within the 15-day grace period.

Part 7: How Havellum Can Help You Stay Legal

The common thread in every section above—whether it is RCL, MLOA, or Tuition Refunds—is the absolute necessity of medical documentation.

US universities and immigration officials operate on paper. Your word is not enough. You need a professional, verifiable medical certificate to prove that your condition is real and warrants an exception to federal visa rules.

However, the US healthcare system is often inaccessible for international students. Wait times for specialists can be months, and emergency rooms are prohibitively expensive.

This is where Havellum serves as your essential partner.

Why International Students Trust Havellum

1. Meeting the "Licensed Professional" Standard
   As mentioned, immigration regulations require documentation from specific types of professionals. Havellum connects you with licensed medical providers who are qualified to assess your condition and issue the necessary medical certificates. We understand the specific language required by university registrars and DSOs.

2. Speed Saves Status
   In visa matters, timing is everything. If you miss the "Add/Drop" deadline or the "Withdrawal" deadline because you are waiting for a doctor's appointment, you could be liable for thousands of dollars in tuition or risk falling out of status.

3. Efficiency: Havellum allows you to complete an assessment online and receive your documentation rapidly, often within hours. This allows you to submit your RCL paperwork before the critical deadlines pass.

4. Financial Safety
   You are likely already losing money on tuition; you shouldn't have to spend hundreds more on urgent care visits just to get a note. Havellum operates on a transparent, flat-fee model. We are a cost-effective solution for students who may have waived school insurance or are facing high deductibles.

5. Verifiable Proof
   Submitting a fake or questionable note to a university is grounds for expulsion and visa revocation. Do not risk it.

6. Authenticity: Havellum provides 100% legitimate medical certificates signed by licensed professionals.
7. Verification: Each document includes a secure verification link. When your DSO or Registrar clicks it, they can confirm the note is authentic, smoothing the path for your leave approval.

Protect your health and your visa.
Don't let the bureaucracy of the US healthcare system jeopardize your education. Get the verifiable medical documentation you need today at Havellum.com.