This question was recently asked of the ThinkHR Hotline team: What benefits must be continued while an employee is on Family and Medical Leave Act (FMLA) leave? What should we do with an employee who is not making his share of the copayments while out on leave?
Their expert answer: Family and Medical Leave Act (FMLA) regulations require that employers continue to provide group health benefits under the same terms and conditions as if the employee were actively at work. There is no FMLA requirement to continue other types of employer benefits; whether those continue depends on the employer’s established policies. Any benefits that would be maintained if the employee were on another form of leave should be maintained while the employee is on FMLA leave.
Part of the requirement to continue health insurance benefits “under the same terms” means that both the employer and employee must continue to pay their portions of the group health insurance premium, unless the employer has a different written policy for managing premium payments during leaves. The employer must notify the employee of the payment requirements while on leave, including the amount owed, the due date, and where the payment should be sent. If the employee fails to pay his or her portion of the premium, the employer may be able to suspend group health benefits for the remainder of the FMLA leave under certain procedures.
To suspend benefits for nonpayment while an employee is on FMLA leave, an employer should allow a 30-day grace period after the original payment due date. The employee must receive written notice at least 15 days before the actual suspension; a common practice is to send a pending-suspension notice once the employee is 15 days past the payment date. Even if coverage is suspended for missed premiums, the employer must restore the employee’s coverage without penalty or delay when the employee returns from FMLA to the same level of coverage held before the leave, provided the employee is otherwise eligible. If the employee does not return from FMLA, the employee whose coverage was suspended for failure to pay premiums during leave would generally be eligible for COBRA continuation coverage.
Employers that operate medical practices or similar businesses should also review their broader insurance programs and policies; for example, see Medical Offices Insurance.
Other industry-specific insurance programs may be relevant to business operations and compliance; for example, businesses that handle medical waste should consider specialized coverage such as the Medical Waste/Refuse Haulers Insurance Program.
Don Phin, Esq. is VP of Strategic Business Solutions at ThinkHR, which helps companies resolve workforce issues, mitigate risk, and ensure HR compliance. For help interpreting plan documents or applying these rules to your workplace, talk to an agent.
Frequently Asked Questions
Which benefits must an employer maintain during FMLA leave?
Employers must maintain group health insurance on the same terms as if the employee were working; continuation of other benefits depends on employer policy.
Can an employer require employees to continue paying their share of premiums while on FMLA?
Yes. Employers may require employee premium contributions during FMLA and must notify the employee of amount, due date, and payment instructions.
What if an employee misses premium payments while on FMLA?
The employer may suspend coverage after providing a 30-day grace period and at least 15 days’ written notice before suspension, but must restore coverage when the employee returns from leave if eligible.
Are other benefits like life or disability coverage automatically continued during FMLA?
No. Continuation of non-health benefits during FMLA depends on the employer’s established policies and how those benefits are treated during other types of leave.