FMLA and Your Group Health Insurance Policy:

The Family and Medical Leave Act or FMLA was instituted in 1993 to provide protection for employees to have up to twelve weeks of unpaid leave within one twelve week period where they would not be at jeopardy of losing their job. FMLA also provides protection for an employee who needs to take a leave so that they will not lose their health insurance coverage during their leave.

FMLA affects employers in the private sector who have fifty or more employees. If your company employees less than fifty people, you will not be affected by FMLA. However, if you wish, you may still follow these regulations to provide protection for your employees.

Intermittent leave is also covered by FMLA. This means that if an employees takes their leave period in smaller amounts, or if they are forced to work on a reduced schedule, they will enjoy the protection of the FMLA act. Not all intermittent leaves will qualify, but here are a few examples:

Leave Granted for a Serious Condition

This is usually determined by a "medically necessary" emergency that deals with the health of your employee, their spouse or their children. It means that if an employee requests intermittent leave for this reason, they will be under the protection of FMLA. You may be able to require a physicians notice to prove that the leave is being used for a "medically necessary" condition or emergency.

Medical Necessity

This is similar to the above provision, and allows for an intermittent or reduced leave when there is a specific medical need for it. For example, if an employee needs to request a leave for a medically necessary treatment, this would be protected under FMLA. However, if the leave is for liposuction, it may not qualify. The key to this area is "medically necessary."

Birth or Placement of a Child

If your employee gives birth to a child, or has adopted a child, they may request intermittent leave or reduced leave and still have the protection of FMLA. This is only applicable if both the employer and the employee agree upon it first. Otherwise, the employee will not have this protection. There are exceptions, such as the health of a newborn or adopted child, or a serious health condition affecting the mother after the birth of a child.

In some cases, your employee may need to leave for a only a few hours a day. This is usually the case for medically necessary physical therapy. They can then elect to take an unpaid leave or transfer to a position in your company that will work around their therapy, as long as there is equivalent pay and benefits. This is usually beneficial for both the employee and the employer, as they work around the employee's condition.

You will need to use these guidelines to determine if your employees are eligible for FMLA protection under the law. If they are eligible, you may not cancel their enrollment in your group plan or fire them for this reason. You will also need to continue making payments for their premiums in the group health care plan if you are already making these payments before the leave was required.

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