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SECTION 11: EMPLOYEE BENEFITS DURING FMLA/CFRA AND PDL LEAVE

 

Medical and Dental Coverage

During FMLA, CFRA, and/or PDL leave, an employee's group medical and dental coverage and Health Care Spending Account (HCSA) must be continued on the same basis and under the same conditions as were applicable prior to the commencement of the leave. This means:

  • If the employee is in pay status for at least eight hours in any month, the County will pay the employee's full cafeteria plan contribution (e.g. Choices, Options, etc.) or medical subsidy (e.g. temporary, part-time employees).

    Employees are not permitted to use one day a month of accrued time in order to receive their County contribution unless one day of accrued time is all the time an employee has remaining.

  • If the employee is not in pay status during the month FMLA, CFRA, and/or PDL leave is taken, the County will pay the lower of the following for health benefits:

    Ø The full premium of the County sponsored or County approved

    union sponsored medical plan, the full premium for the County sponsored dental plan and the HCSA contribution amount in which the employee was enrolled prior to the leave. “Full premium” includes the premium for dependent coverage.

    or

    Ø The County contribution to the cafeteria plan in which the employee

    is enrolled, or, in the case of temporary or recurrent employees, the full subsidy toward health insurance.

  • If the employee paid any portion of the premium for his or her medical coverage prior to the FMLA, CFRA, and/or PDL leave, he or she will be billed for the same amount while on leave. The employee with cafeteria plan benefits will receive the cafeteria plan contribution for benefits in the following order: medical, dental then HCSA. If the contribution amount does not fully cover the cost of these benefits, the employee will be billed for the remainder of the cost for each benefit. However, while on FMLA/CFRA, and/or PDL leave, these payments will be on an after tax basis rather than a pre-tax basis. Employees will be billed by the Employee Benefits Division of the Department of Human Resources.

 

The County has no obligation to continue medical and dental coverage for any of the following reasons:

  • The employee was not enrolled in a medical plan, dental plan or HCSA prior to the FMLA, CFRA, and/or PDL leave. Employees are not permitted to change their enrollment because of FMLA, CFRA, and/or PDL leave. However, if the employee has a “Change of Status” as defined under the cafeteria plans, the employee may be qualified to change his or her enrollment.

  • The employee's medical, dental or HCSA coverage is canceled or suspended during the FMLA, CFRA, and/or PDL leave. This may occur when the employee must pay a part of the medical or dental premium and prefers not to do so. In this case, the County will suspend the employee's coverage until the first of the month after he or she returns to work, except coverage continues in the months a partial HCSA deduction is taken from the employee's paycheck.

  • The employee notifies the department that he or she will not return from FMLA, CFRA, and/or PDL leave.

  • The employee fails to return to work on the expected return date without notifying the department or requesting an extension.

  • The employee exhausts his or her FMLA, CFRA, and/or PDL entitlement.

If the employee fails to pay his or her portion of the premium, the Employee Benefits Division of the Department of Human Resources will:

  • Suspend the coverage when the payment is more than 30 days late. The suspension of coverage will take effect on the first day of the month following the last month for which the premium payment was made. For example, if the last premium payment was made for May, the suspension of coverage would take effect on the first day of June. The County will suspend the employee's coverage until the first of the month after he or she returns to work.

Under FMLA, CFRA and/or PDL, the County is entitled to recover any premium payments made on behalf of the employee during an unpaid leave if he or she fails to return from FMLA, CFRA, and/or PDL leave after the leave entitlement has been exhausted or the leave expires, unless:

  • The employee is unable to return to work because of the continuation, recurrence or onset of a serious health condition which would entitle the employee to continue FMLA, CFRA, and/or PDL leave.

  • The employee is unable to return to work due to unexpected circumstance(s) beyond the employee's control.

 

“Return to Work” means a return to active County employment for at least 30 calendar days or retirement under the County retirement system within the first 30 calendar days.

Premium payments made on behalf of the employee for the entire period of FMLA, CFRA, and/or PDL unpaid leave may be recovered from the employee. However, the County has no right to recover for premiums paid for any month in which the employee was in a pay status for at least eight hours.

An employee who is required to be out on unpaid leave after his or her FMLA, CFRA, and/or PDL expires may continue his or her medical and dental coverage and should direct their questions regarding premiums to the Employee Benefits Division of the Department of Human Resources.

Consolidated Omnibus Budget Reconciliation Act (COBRA) Coverage

An employee who terminates County service retains the right to continuation of health insurance under COBRA.

All questions regarding premium payments and/or COBRA should be referred to the Employee Benefits Division of the Department of Human Resources.

Non-Student Part Time Employees on FMLA/CFRA and PDL

Effective January 1, 2007, non-student part-time employees are eligible to enroll in a medical plan provided they worked an average of 20 hours per week during a three consecutive month period. An employee will be deemed to be in a pay status for an average of 20 hours a week for the three consecutive months prior to enrollment if:

  • The employee is on a daily or hourly item and the employee's total pay status hours for the three consecutive months prior to enrollment is equal to or greater than 244 hours.

  • The employee is on a 1/2 time, 3/5 time, 5/8 time, or 2/3 time monthly item and the employee's total pay status hours for the three consecutive months prior to enrollment are equal to or greater than 256 hours.

Medical coverage will continue through June 30 of the next year, as long as the employee works a minimum of 8 hours in a month. Employees must work the required average of 20 hours per week during January, February and March of the next year, to continue coverage after June 30. If they don't work the required average hours during January, February, and March, coverage is cancelled July 1. After July 1, employees may later re-qualify and be eligible to enroll in a medical plan if they work an average of 20 hours per week during a three consecutive month period.

 

FMLA allows employers to proportionately reduce benefits where an employer's normal practice is to base such benefits on the number of hours worked while the employee is on FMLA leave. For example, if the benefit plan is predicated on a pre-established number of hours worked each year and the employee does not have sufficient hours as a result of taking unpaid FMLA leave, the benefit is lost. Therefore, part-time employees that fail to meet the requisite hour's requirement may lose medical coverage until the employee re-qualifies and re-enrolls in a medical plan. For more information on medical coverage for non-student, part-time employees, please contact the Employee Benefits Division of the Department of Human Resources.

Health Care Spending Account (HCSA)

It is the employee's choice whether or not to continue with the monthly contribution into the HCSA. If the employee continues to make the contribution or has a partial contribution deducted from the employee's paycheck, he or she will be entitled to submit a request for reimbursement of any eligible charges incurred during the months the employee had a contribution to the HCSA during the FMLA, CFRA, and/or PDL leave period.

If the employee chooses not to make the monthly contributions, he or she may not submit a request for reimbursement of any charges incurred during the FMLA, CFRA, and/or PDL leave period. However, when the employee returns from FMLA, CFRA and/or PDL leave, his or her monthly contribution will resume and he or she will be entitled to submit a request for reimbursement of any eligible charges incurred prior to and/or after the FMLA/CFRA, and/or PDL leave.

Other Benefits

An employee may also continue benefits other than medical, dental and HCSA, including Life insurance, Accidental Death & Dismemberment (AD&D), Survivor in Benefit (SIB) and Long Term Disability (LTD) Health Insurance. The Employee Benefits Division of the Department of Human Resources will bill an employee monthly for the cost of these other benefits, under “direct pay.” If the employee does not pay for the cost of one or more of these other benefits, the benefit(s) will be canceled. Benefits will be reinstated on the first of the month following the month the employee returns to work.

 

Other Guidelines Regarding Benefits

  • Employees who are in cafeteria plans retain their right to enroll during the County annual enrollment period even if they are on FMLA and/or CFRA, and PDL leave during the enrollment period.

  • Employees on FMLA, CFRA, and/or PDL leave retain their right to change their enrollment, in accordance with the plan rules, if they have a “Change in Family Status” during the period they are on FMLA, CFRA, and/or PDL leave. For example, an employee who has a baby has the right to change his or her health insurance coverage from employee and spouse to family coverage.

  • Benefit changes which apply to all participants or employees (change in coverage, deductibles, premiums, methods of time accrual, etc.) also apply to the employee on FMLA, CFRA, and/or PDL leave and take effect on the same date as for all other participants or employees.

  • The County's established policy for County retirement and saving plan contributions, holiday pay, etc. apply to employees on unpaid FMLA and or CFRA, and/or PDL leave in the same manner as it does to employees on other types of unpaid leave.

 

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