FMLA protects the job and the health coverage during leave.
The Family and Medical Leave Act gives eligible employees job-protected leave for qualifying family and medical reasons, and it requires employers to continue group health coverage during that leave.
The Basics for Employers.
A plain-English summary. This is general information, not legal advice, and the rules change, so check the current text.
Which Employers Are Covered
Private employers with 50 or more employees for at least 20 workweeks in the current or prior year are covered, and public agencies and schools are covered regardless of size.
Which Employees Qualify
An employee generally needs 12 months with the employer, 1,250 hours worked in the past year, and a worksite with at least 50 employees within 75 miles.
Coverage During Leave
Eligible employees can take up to 12 weeks of unpaid leave in a year, and the employer keeps their group health coverage going on the same terms.
How it plays out.
FMLA gives eligible employees up to 12 weeks of job-protected leave in a year for qualifying reasons, and up to 26 weeks in a 12-month period for military caregiver leave. It applies to employers with 50 or more employees within 75 miles, and to employees who meet service and hours tests.
The benefits point is that group health coverage generally has to continue during FMLA leave on the same terms as if the employee were working. The employer keeps paying its share, and the employee keeps paying theirs, so the question is how the employee’s share is collected while no pay is coming in.
If an employee does not return, the employer may be able to recover its share of premiums in some cases, subject to the rules. That is a point to confirm with counsel before acting.
Where This Shows Up in Your Plan.
Caregiver Support, Sick Time and Paid Leave: Benefits That Work With Your Health Plan
How leave policies fit alongside your health plan.
COBRA Administration
What happens to coverage if the employee does not return.
When leave starts.
Confirm Eligibility
Check FMLA coverage and the employee’s eligibility.
Explain Premium Payment
Tell the employee how their share will be paid during leave.
Keep Coverage Active
Do not terminate coverage in the system without checking.
Plan the Return
Set what happens to coverage when leave ends.
Mistakes to avoid.
Terminating Coverage at Leave Start
Coverage generally has to continue.
No Premium Plan
Without one, a missed payment becomes a coverage question.
Ignoring State Rules
State leave laws can add to the federal rules.
Other Rules Employers Work With.
Laws and Rules Referenced
Family and Medical Leave Act (29 U.S.C. Chapter 28) — The statute text, published by Cornell Law School’s Legal Information Institute.
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