Leaves of Absence - Do Employers Need to Provide Health Insurance During These Times?

FMLA, Health Insurance, Leave of Absence

Employees who take qualifying leaves of absence are provided multiple protections by way of the Family and Medical Leave Act (FMLA) and the Uniformed Services Employment and Reemployment Act (USERRA).

The most well-known protection is the guarantee of the same or an equivalent job when employees return to work, but there are also other protections. Here is a breakdown of FMLA and USERRA laws with regards to employer-provided health insurance coverage.

FMLA and Health Insurance

In order to meet the requirements for an FMLA-qualifying leave of absence, employees must meet four criteria:

  • Have completed 12 months of work for the employer (not necessarily consecutively)
  • Have completed 1,250 hours of work in those 12 months
  • Work at a location where there are at least 50 employees present or within 75 miles
  • Have a qualifying event

There are many qualifying events, ranging from the birth or adoption of a child, to serious health conditions, to providing for family members who have serious health conditions. Having a family member called to active military duty also qualifies (and extends FMLA benefits from 12 to 26 weeks).

Whenever the above criteria are met, FMLA requires employers to maintain continuous group health coverage throughout a qualifying leave of absence. So long as employers normally require employees to pay a share of their health insurance premiums, the same requirement can be continued throughout the absence -- employers don’t have to pay the full premium unless that’s their standard practice.

USERRA and Health Insurance

All employees who are called to active duty military service qualify for USERRA leave of absence, regardless of how many employees they work with, how long they’ve worked for their employer, or how many hours they’ve worked. There is no minimum employee requirement, so all employers must follow this regardless of their business’ size.

In USERRA leaves of absence, employers are still required to make group health coverage available if the employee would otherwise have it. Who pays the premiums for coverage depends on how long the active duty lasts.

For leaves of absence lasting less than 31 days, premiums must be paid as normal. The employer and employee are each required to pay their share of the premiums.

For leaves of absence that last 31 or more days, the entire cost of health coverage can be shifted onto the employee. This includes the full premiums plus up to a 2 percent administrative fee. (The administrative fee may not exceed 2 percent.)

Navigating Your Employees' Leaves of Absence

Reach out to our team at KBI at (408) 366-8880 to help you navigate health insurance and other benefits issues that arise when your employees file for any of these leaves of absence.  Our consultants will work with you to make sure health coverage is in place should your employees file an FMLA or USERRA request.

Tagged: FMLA, Health Insurance, Leave of Absence