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Compliance
Steps
Step
8: Review Employer’s Obligation to Provide Benefits During Leave
During
any FMLA leave, you must maintain the group health plan
coverage for the employee and the employee’s dependents on the
same conditions as coverage would have been provided if the employee
had been continuously employed during the entire leave period.
A
"group health plan" means any plan "of, or contributed
to by, an employer (including a self insured plan) to provide
health care (directly or otherwise) to the employer’s employees,
former employees, or the families of such employees or former
employees."(1)
Medical, surgical, hospital, dental and/or eye care, mental health
counseling, substance abuse treatment benefits, etc., must be
maintained during leave if provided in the employer’s group health
plan. This includes any existing supplemental benefits to a group
health plan, whether or not provided through a flexible spending
account or other part of a cafeteria plan.
While
an employee is on FMLA leave, you also should maintain non-health
benefits as well as group health plan benefits. Typical
"non-health" benefits include: life insurance, long or
short term disability insurance, accidental death insurance, holiday
pay, etc. It is important to maintain non-health benefits even
though the FMLA does not specifically require this, because the FMLA
does require an employer to restore the employee to benefits and
coverage (not limited to group health plan coverage) equivalent to
what the employee would have had if the leave had not been taken.
This may not be possible if coverage lapses on a benefit plan due to
the employee’s failure to pay premiums during FMLA leave.
Consequently, most employers will choose to maintain the non-health
benefits during an FMLA leave to avoid this possibility, and related
liability.
In
short, you may need to make premium payments that the employee fails
to make during the FMLA leave in order to ensure full eligibility
for all types of group health plan and other non-health insurance
benefits upon his or her return.
After
reviewing these obligations, proceed to the next step.
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(1)
The term "group health plan" does not include certain
insurance programs providing health coverage under which employees
purchase individual policies from insurers. These plans receive
no contributions are made by the employer, are completely voluntary
for employees, and are almost exclusively administered by the
insurance company, not the employer. If you are uncertain whether
your plan qualifies as a "group health plan" or a voluntary
employee pay-all insurance plan, contact experienced employment
counsel.
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