Employee Health Insurance Benefit Protections under the Family and Medical Leave Act

Author, Jadyn Brandt, Client Communications Coordinator, Rancho Mesa Insurance Services, Inc.

When an employee takes leave provided to them by the Family Medical Leave Act (FMLA), an employer may be left with a number of questions concerning what protections they are required to give to said employee. ‍

The FMLA allows employees to take up to 12 weeks of leave from work for personal or family medical reasons, and return to the same job or an “equivalent job” when their leave ends. An equivalent job is a role where the pay, benefits, employment terms, and often schedule and location are identical to the employee’s original job.

FMLA leave is unpaid leave, but employee health insurance benefits can continue while the employee is on leave, so long as the employee continues to make regular contributions to insurance premiums.

The U.S. Department of Labor states these contributions can be made by the employee in a number of ways. Most commonly, these payments are made through payroll deductions when an employee has elected to take paid leave along with FMLA leave. If an employer does not require an employee take paid leave and the employee opts to take only FMLA leave, an employer may make payments on the employee’s behalf that the employee will then need to repay upon returning to work.

The terms under which an employee receives health insurance coverage through an employer must also remain the same while on FMLA leave. For example:

• Employees who have family member coverage must continue to receive family member coverage.

• All forms of benefit coverage including medical care, surgical care, hospital care, dental care, eye care, mental health counseling, and substance abuse treatment must adhere to pre-FMLA leave terms.

• Employees must be notified and given the opportunity to make changes to plans or benefits.

An employee can also elect not to continue coverage through an employer’s group health plan. However, upon returning to work the employee has the right to return to the same coverage levels as before and, “no qualifying periods or physical examinations may be required, and no exclusions based on pre-existing conditions may be applied.”

An employee returning from FMLA leave must also be allowed to resume receiving benefits at the same level and manner as before the FMLA leave began including: life insurance, disability insurance, sick leave, vacation, educational benefits, pensions, and retirement or 401(k) benefits.

For more information on FMLA leave requirements, login to the RM365 HRAdvantage™ portal or visit the U.S. Department of Labor website. Individual states may have additional requirements, so consult an HR expert or attorney who is knowledgeable about your state’s laws.

For a list of Rancho Mesa FMLA resources, read or listen to FMLA Made Easier: Tools and Resources for Employers Navigating Leave Laws.