Are Employers Required to Provide Health Insurance During a Leave of Absence?

When an employee takes a leave of absence for “qualifying conditions” there are potential obligations to be met by the employer. These obligations are provided under protections of the Family and Medical Leave Act (FMLA), the Uniformed Services Employment and Reemployment Act (USERRA), and potentially state laws as well.

Employer

For a leave of absence to be considered “qualifying” employees must meet certain conditions for employers to be obligated to maintain group health insurance coverage through the leave of absence period.

Employees must meet the following conditions —

  • They must have worked for the employer for 12 months, not necessarily continuously
  • Those 12 months of cumulative employment must have contained 1,250 hours of work
  • The employee must have worked at a location with at least 50 employees either at that location or within 75 miles
  • There must be a qualifying event
  • Birth or adoption of a child
  • Serious health conditions preventing normal work
  • Providing for others with serious health conditions
  • Having a family member called to active military service (this also extends FMLA benefits from 12 to 26 weeks)

If an employer requires employees to pay part of their health insurance coverage as a standard practice, this can continue through the leave of absence. Employers are not required to fully pay health coverage unless that is the normal benefit offered to all employees.

For employees qualifying under USERRA rules, the qualifications are a bit different. There are no minimum employee requirements for employment time or company size, so all employers must follow these requirements which include:

For leaves of less than 31 days, premiums must be paid as though the employee is present. Employers and employees are required to pay their respective premiums.
For leaves of 31 days or longer, the cost of health insurance coverage shifts to the employee. This includes full premiums plus a maximum of two percent administrative fee.
The employee must regain their normal benefits without any exceptions or waiting periods when they return from active duty.

Employees are not required to pay for benefits since they are often covered by military health care while in active service, and therefore may not take advantage of the option. Regardless, employers must offer it.

Employers must also adhere to any state laws that vary from either FMLA or USERRA laws. These laws vary from state to state but could include longer coverage requirements for employers or a requirement to cover additional family members.

Health insurance requirements are complex issues requiring a thorough knowledge of federal and state laws. First Day Films can assist employers who need to communicate health insurance coverage, open enrollment, or human resources issues to employees quickly and efficiently. Call us for more information at 833-422-7332.