This document describes continued benefit coverage during a leave of absence, tells what to give employees who elect to continue benefits, explains the Research Foundation's (RF's) reinstatement of benefits policy after a leave, and states the penalty for nonpayment of premiums.
Employees may continue benefits coverage when on the following types of authorized leave, each of which is described in the sections that follow:
See Benefits Coverage Continuation When Disabled for employees on disability leave without pay, and "FMLA: Guidelines for Administering Leave" for more information on FMLA.
During periods of approved leave under FMLA, an employee may continue coverage through premium payments as follows:
Operating locations are required to provide employees with information on benefits continuation during a family and medical leave.
The following documents, as a package, should be provided to employees once the family and medical leave has been approved:
A copy of the completed application should be sent to central office benefits administration unit. Central office will ensure that a system input is made to maintain the employee's benefit eligibility status.
Premium arrangements must be made before the leave. If an employee elects payment of the health insurance premium on a pretax basis, full payment can be deducted from his or her last paycheck. The premium can be paid monthly or biweekly on an after-tax basis.
When an employee returns to employment following FMLA leave, all benefits for which the employee was eligible before the leave will be reinstated without a waiting period, even if benefits were not continued during the leave.
At the time of new enrollment for health insurance coverage, an employee would have met a 42-day waiting period and would have taken a double deduction in advance to allow for a 28-day extension of coverage. The following table describes what happens under different circumstances after a leave of absence under the FMLA:
If... |
Then... |
The employee returns to work after having continued health insurance coverage during FMLA leave. |
There is no 42-day waiting period for health insurance coverage, and the 28-day extension of coverage remains intact. |
The employee returns to work after not continuing health insurance coverage during FMLA leave. |
There is no 42-day waiting period for health insurance coverage. |
The employee does not return to work after the maximum 12-week* FMLA period but continues his or her leave as leave of absence without pay (LOA). |
A new waiting period will be required upon return to work, unless the employee continues benefits by paying the entire premium (employer and employee share) for the time beyond 12 weeks.* |
The employee does not return to work after FMLA leave expires. |
Benefits cease. The RF can recover its share of the premium from the employee. An exception is made if the employee does not return to work because of circumstances beyond his or her control (for example, the employee’s spouse is transferred to a distant job). |
* In case of Military Caregiver Leave, the period is 26 weeks, not 12.
While on an approved leave of absence for up to one year, an employee may continue health, dental, vision care and life Insurance coverage by paying the full premium directly to the RF. All benefits (health, dental, vision care and life insurance) may be continued or just health insurance. If health insurance is not continued, dental, vision care and life insurance may be continued only as a package.
Claims made while an employee is in active, eligible status will count toward policy deductibles and limitations during the continuation period.
For circumstances under which leave may be taken and for eligibility requirements, see the Leave Policy.
Operating locations are required to provide employees with information on benefits continuation during a leave without pay other than family and medical leave.
After the LOA has been approved, operating locations should provide employees with the following documents as a package:
A copy of the completed application should be provided to central office benefits administration unit. Central office will ensure that a system input is made to maintain the employee's benefit eligibility status.
Premium arrangements must be made prior to the leave. The employee may make one payment for the full period of the leave or monthly or biweekly payments. Payments will be taken on an after-tax basis, unless the employee is still on the payroll. Employees on leave of absence are charged for each pay period missed and the premium paid by the employee represents the biweekly charge (employer and employee share) for each payroll period during which the person does not receive a paycheck.
At the time of new enrollment for health insurance coverage, an employee would have met a 42-day waiting period and would have taken a double deduction in advance to allow for a 28-day extension of coverage. The following table describes what happens to the waiting period and the extension of coverage under different circumstances after a leave of absence without pay:
If... |
Then... |
The employee returns to work after having continued health insurance coverage during LOA. |
There is no 42-day waiting period for health insurance coverage, and the 28-day extension of coverage remains intact. |
The employee returns to work after not continuing health insurance coverage during LOA. |
A new 42-day waiting period must be met at the time the employee returns to active employment, and another double deduction must be advanced to allow for a new 28-day extension of coverage. |
The employee does not return to work after having continued health insurance coverage during LOA. |
Health benefits are extended to 28 days beyond the leave of absence period, and benefits cease. |
The employee does not return to work and did not continue health insurance coverage during LOA. |
Benefits cease. |
Refer to the Leave of Absence Without Pay section in this document and the RF Leave Policy.
During periods of approved military leave under USERRA and VBIA, an employee may continue coverage through premium payments as follows:
See the RF "Leave Policy" for circumstances under which leave may be taken and for eligibility requirements.
Operating locations are required to provide employees with information on benefits continuation while on military leave.
Operating locations should provide a completed copy of the application to central office benefits administration unit. Central office will ensure that a system input is made to maintain the employee's benefit eligibility status.
Premiums arrangements must be made prior to the leave. An employee may make one payment for the full period of the leave, pay monthly, or make biweekly payments. Payments will be taken on an after-tax basis, unless the employee is still on the payroll. The employee is required to pay the same share of the premium as an active employee for the first 12 weeks* of leave, the full premium after 12 weeks* and up to one year from the beginning date of military service, and the COBRA premium rate (100 percent premium plus the 2 percent administrative fee) for the next 12 months.
* In case of Military Caregiver Leave, the period is 26 weeks, not 12.
Subject to the reemployment rules described in Military Leave, all benefits for which the employee was eligible before the military leave will be reinstated, without a waiting period, upon the employee’s return. Any benefit for which the employee was eligible that became effective during the military leave will become effective upon the employee’s return to RF employment.
During FMLA, LOA, and military leave, coverage will be cancelled if premium payments are not received within 30 days of the due date.
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