What You Need to Know About FMLA and Health Insurance
The Family and Medical Leave Act, FMLA, was instituted in 1993 as a means to provide protection to employees and their families against losing health insurance when life circumstance require an interruption in work for a short period of time. The FMLA act stipulates that families can receive up to twelve weeks of unpaid leave within one twelve week period without the jeopardy of job loss, or the loss of health insurance coverage.
The FMLA act affects all employers in the public sector as well as those in the private sector who carry fifty or more employees. Companies with less than fifty people working are not required to follow the FMLA act, but may provide the needed protection to their families if they choose to.
The FMLA act covers intermittent leave as well. Even when an employee takes their leave in smaller periods of time, they still receive the full protection of the FMLA act. Not all intermittent leave qualifies, but here are a few examples of some that do:
FMLA Leave Granted for a Serious Condition
Serious condition leave most often means a "medically necessary" emergency for the employee, their spouse or children. An employee requesting intermittent leave for a serious condition automatically falls under the protective umbrella of FMLA. A physician’s note is often required to authenticate the condition or emergency.
FMLA and Medical Necessity
Similar to leave granted for a serious condition, medical necessity leave allows for intermittent or reduced leave when there is a specific medical need. For example, if an employee requests time off for an essential medical treatment, they are protected under FMLA. However, when the leave is for something frivolous (liposuction for example), it will not qualify.
FMLA for the Birth or Placement of a Child
Intermittent or reduced leave is granted when an employee gives birth to, or adopts, a child, but only when the employer and employee have agreed beforehand. There are exceptions, such as the health of a newborn or adopted child, or a serious health condition that affects the mother immediately after the child’s birth.
In some instances employees may need to leave for only a few hours per day, as is usually the case for medically necessary physical therapy. Employees may elect to take an unpaid leave or transfer to a position in the company that will work around their therapy, as long as pay and benefits are equivalent.
Employers must follow the guidelines to determine if their employees are eligible for FMLA protection as stated under federal law. Employees who do fall under FMLA protection cannot have their group plan enrollment canceled, nor can they be fired. In addition, employers must continue to make payments for the premiums in their group health care plan if they were already making them before the leave was required.
FMLA leave ensures that workers can take time out to care for their families without losing health insurance benefits. For more information on FMLA, please visit the U.S. Department of Labor’s website at http://www.dol.gov/esa/whd/fmla/