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FMLA and Health Insurance

FMLA and Health Insurance. Risks and Things to Consider. Brice Christensen Client Advisor, Employee Benefits Abbey Vanderwerf Vice President, Employee Benefits 04/24/2019. Agenda. Importance FMLA Basics Identifying Your 12 Month Period FMLA and the ACA Where to Begin.

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FMLA and Health Insurance

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  1. FMLA and Health Insurance Risks and Things to Consider Brice Christensen Client Advisor, Employee Benefits Abbey Vanderwerf Vice President, Employee Benefits 04/24/2019

  2. Agenda • Importance • FMLA Basics • Identifying Your 12 Month Period • FMLA and the ACA • Where to Begin

  3. Why is this important to me?

  4. Employee and Employer Protections • Employee • 12 weeks of protected leave • Including health insurance • Employer • Limit liability • Termination of employment • Termination of health insurance

  5. What’s the worst that can happen?

  6. FMLA Basics

  7. FMLA Basics • Requires Covered Employers to provide Eligible Employees up to 12 weeks of unpaid, job-protected leave per year • Leave must be for reasons required by law (Covered Reasons) • Employers and employees have specific rights and remedies under the FMLA • The FMLA provides specific rules for group health benefits coverage • Employers must generally restore employees to their position or equivalent position upon return from FMLA leave

  8. Covered Reasons • Birth of a child and to take care of newborn, including prenatal care and bonding time • Placement of a child for adoption or foster care • To care for an immediate family member with a serious health condition • Employee’s own serious health condition • Qualifying exigent circumstances (a covered service member has been notified of an impending call to active duty) • To care for a covered service member's serious injury or illness (a/k/a “military caregiver leave”)

  9. Serious Health Condition • Illness, injury, impairment, or physical or mental condition; • Requires inpatient care or continuing treatment by a health care provider; and • Involves more than three days of incapacity. Burden is on the employer to determine if condition is FMLA qualified.

  10. Intermittent Leave • Employers have to allow intermittent or reduced schedule leave under certain circumstances • Medical need for such leave • Qualifying exigencies (military leave) • Not required for birth or adoptions, but employer may agree to it Example: Leave for newborn well-care appointments are not FMLA-protected but could be allowed by employer.

  11. Concurrent Leaves • Recommend leave policy to require using paid leave while on FMLA leave. • Accrued leaves (Sick, Vaction, etc.) • Disability/Workers Compensation If a leave is eligible for FMLA, it is always advisable to treat it as FMLA leave.

  12. Identifying Your FMLA Leave Year

  13. FMLA Leave Year • The Department of Labor allows employers choice for an FMLA Leave Year. • Calendar Year • Any Fixed 12 Months • The 12 month period measured forward • A “rolling” 12 month period measured backward

  14. FMLA Leave Year

  15. FMLA Leave YearDifferent Leave Year, Different Results Employee requests leave in two years • Calendar Year – Both leave requests are granted • First leave: 9.1.2018 – 11.1.2018 (8 weeks) • Second leave: 3.1.2019 – 6.1.2019 (12 weeks)

  16. FMLA Leave YearDifferent Leave Year, Different Results Employee requests leave in two years • Rolling Forward – Only 4 weeks of 2nd leave qualifies as FMLA • First leave: 9.1.2018 – 11.1.2018 (8 weeks) • Second leave: 3.1.2019 – 6.1.2019 (12 weeks) September 2018 September 2019 First Leave Request 8 Weeks Second Leave Request 12 Weeks 9/1 9/1 11/1 3/1 6/1 3/1

  17. FMLA Leave YearDifferent Leave Year, Different Results Employee requests leave in two years • Rolling Backward – Only 4 weeks of 2nd leave qualifies as FMLA • First leave: 9.1.2018 – 11.1.2018 (8 weeks) • Second leave: 3.1.2019 – 6.1.2019 (12 weeks)

  18. FMLA and the ACA

  19. FMLA and the ACA When should we term from health insurance? • ACA protected stability period • Does employee “measure” as full time? • Monthly or Look-Back?

  20. FMLA and the ACA Determining FTE Status • Monthly Measurement Method • When concurrent with paid leave, an employee earns hours of service for FTE determinations • Unpaid FMLA leave does not count as hour of service for FTE determination • Look-back Measurement Method • If an employee is on FMLA leave during a stability period for which he was full-time, coverage continues • Determine FTE at next Admin Period

  21. ACA Periods • Clearly define measurement method • Look-Back, Monthly • Select length of measurement period • Between 3 and 12 months • Select length of stability period • Between 6 and 12 months • Select length of administrative period • Between 1 and 3 months

  22. FMLA and the ACA

  23. Where To Begin

  24. Concurrent leaves: Enforce use of sick or vacation leave alongside allotted FMLA leave

  25. Other things to consider • Medical certification process • Allows employer to know if condition qualifies • Designation notice • How to let employee know if leave qualifies • Notice of changes • 60 day notice for change to Leave Year

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