The federal Family and Medical Leave Act (FMLA) allows eligible employees to take a specific amount of unpaid leave for serious illness, the birth or adoption of a child, to care for a spouse, child, or parent who has a serious health condition, to care for family members wounded while on active duty in the Armed Forces, or to deal with any qualifying exigency that arises from a family member’s active duty in the Armed Forces. When required by law, employer sponsored benefit programs must comply with the Family and Medical Leave Act (FMLA). 

Eligibility Criteria

This law provides continuation rights for health expense coverage assuming the Employer/Plan Sponsor meets certain criteria during the preceding calendar year and provided that you have met the eligibility criteria for the law. If the Employer/Plan Sponsor is subject to the law and you are covered under health benefit plans, you may be able to continue the coverage under the employer sponsored benefit plan for a certain period of time.

Benefits Continuation

If you take an FMLA leave, you may continue your group health coverage for you and any covered dependents as long as you pay your portion of the cost for your benefits during the leave. If you take a paid leave of absence, the employer sponsored portion of the cost of group health coverage will continue to be paid by Employer. If you take an unpaid leave of absence that qualifies under FMLA, you may continue your participation as long as you continue to contribute your portion of the premium during the leave. In either case, you are responsible for paying your monthly contribution for your benefits plans during any leave. In some cases, this will require payment during your leave on an after-tax basis. You also have the option to suspend your health coverage during the leave. If you do not make arrangements to pay for your contribution, your benefit coverage may be terminated. 

Change in Status Event

If you experience a change in status event while you are on leave, or upon your return from leave, you may make appropriate changes to your elections. Any coverage that is terminated during your FMLA leave will be reinstated upon your return without any evidence of good health or newly imposed waiting period. If you lose any group health coverage during an FMLA leave because you did not make the required contributions, you may re-enroll when you return from your leave. Your group health coverage will start again on the first day after you return to work and make your required contributions. If you do not return to work at the end of your FMLA leave you may be entitled to COBRA continuation coverage.

Payment of Premiums

To the extent required under the FMLA, and the regulations thereunder, an employee on leave of absence under the FMLA may choose to continue coverage under the Plan by making the applicable contributions, on an after-tax basis, in accordance with procedures established by the Administrator that are consistent with the FMLA. In addition, to the extent required under and in accordance with the FMLA and the regulations thereunder, any Employer/Plan Sponsor contributions made under the terms of the Plan shall continue to be made on behalf of an employee on an FMLA leave.