Leave & Absence Management

Coverage during leave rarely fails on the policy. It fails on the premium nobody collected.

Keeping medical, dental and vision active while someone is out is required during FMLA leave and often promised beyond it. The hard part is the employee’s share of the premium when there is no paycheck to deduct it from. We set up how it is billed and collected, run it through our platform, and write the rules for a late payment before one happens.

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Collecting the Employee Share

The method has to be chosen before the leave starts, not after the first missed payment.

Federal rules allow several ways to collect the employee’s share during unpaid FMLA leave, as long as employees on FMLA leave are not charged more, or asked to prepay more, than other employees on unpaid leave.

Pay as You Go

Payments fall due on the payroll schedule or the COBRA schedule. It is simple to explain and needs a billing process that works for someone who is off payroll, which is where most breakdowns start.

Prepaying Before Leave

When leave is foreseeable, the employee can agree to larger deductions before it begins. It prevents arrears, and it has to be voluntary, so we build it into the leave request rather than presenting it as a requirement.

Catching Up on Return

The employer keeps coverage in place and recovers the employee’s share after return. It is the kindest option and the riskiest, since an employee who does not come back leaves a balance that is hard to collect.

Paid Leave Periods

While PTO or another paid leave is running, the normal payroll deduction continues. The switch from paid to unpaid status is when billing has to begin, so we tie it to the leave record rather than a manual reminder.

How disability income lines up with the leave →

The Rule That Bites

Coverage can be dropped for a late premium only after a waiting period and a written notice.

Under the FMLA regulations, the duty to maintain coverage ends only if the employee’s payment is more than 30 days late, and only after a written notice mailed at least 15 days before coverage stops. Skipping either step turns a missed payment into a reinstatement problem.

The Notice Letter

It must state the date coverage will end and that payment by then prevents it. We draft the letter and set its dates from the billing record, so it is never sent early and never forgotten.

Restoring Coverage on Return

An employee whose coverage lapsed for nonpayment still returns to the same benefits, without a new waiting period or proof of insurability. The insurance contract has to allow that, so we confirm it before any lapse.

Recovering the Employer Share

If an employee does not return, the employer may recover premiums it paid during unpaid FMLA leave, unless the reason is a continuing serious health condition or something else outside their control. Coming back for at least 30 calendar days counts as returning.

What happens when the employee does not return →

Beyond FMLA

Leave that is not FMLA is governed by the plan document, and the insurer has to agree.

Personal leave, extended medical leave and leave after FMLA is exhausted all depend on what the plan says about eligibility for people who are not actively at work.

Plan and Policy Must Match

If HR continues coverage longer than the insurance or stop-loss contract allows, claims in that period may not be covered. We compare the handbook promise with the contract language before either is relied on.

When Leave Becomes COBRA

For an employee who does not return from FMLA leave, the COBRA qualifying event occurs on the last day of leave, and COBRA cannot be conditioned on repaying premiums. The notice timeline starts there, not at the first day of leave.

FSAs During Leave

An employee on unpaid leave can typically revoke, continue or prepay health FSA contributions, depending on how the plan is written. The cafeteria plan document should spell it out, so the answer is not improvised case by case.

How FSA and HRA plans are set up →

Common Questions

What HR asks about coverage during leave.

Do we keep paying our share during unpaid leave?

During FMLA leave, yes, on the same terms as if the employee were working. For other leave, your plan document and policy decide, which is why both should say it plainly.

Can we add an administrative fee?

Not during FMLA leave. Employees on FMLA leave cannot be charged more than their normal share, which differs from COBRA, where a fee on top of the premium is permitted.

What about life and disability coverage?

FMLA’s maintenance rule covers group health plans, including dental and vision. Life and disability follow your policy and the carrier contract, and should be addressed explicitly so nobody is uninsured at the worst moment.

See the full leave and absence program →

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The renewal letter
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