Intermittent FMLA Leave and Employee Health Coverage

One of our full-time employees has asked to take Family and Medical Leave Act (FMLA) leave on an intermittent or reduced leave schedule.  What does this mean, and how does it affect our employee’s health coverage?

The FMLA requires an employer to maintain group health plan coverage during an FMLA leave at the same level and under the same conditions that coverage would have been provided if the employee had been continuously employed during the leave period.

An employee who is entitled to FMLA leave generally may take it intermittently or on a reduced leave schedule if certain conditions are met, including the requirement that the schedule is medically necessary.  Intermittent leave is leave which is taken in separate blocks of time due to a single illness or injury, rather than for one continuous period, and may include leave periods of as little as an hour (for example, leave taken occasionally for medical appointments or several days taken at a time, such as for chemotherapy).

A reduced leave schedule reduces the employee’s usual number of hours per workweek or workday (for example, for an employee recovering from a serious health condition who is not yet able to work full-time).

If your employee takes FMLA leave on an intermittent or reduced leave schedule, you must maintain the employee’s group health plan coverage as if he or she were still working full-time.

Let’s assume that your company has two health benefit packages, one for full-time and one for part-time employees.  If your employee becomes part-time as a result of an intermittent or reduced leave schedule, the FMLA requires that he or she remain eligible for the full-time health benefit package (including the same employer subsidy as other full-time employees who are similarly situated) for the duration of the leave.

Note: The requirement to maintain group health plan coverage during FMLA leave is not limited to major medical plans; it also extends to other group health plans such as dental plans and health FSAs.

The FMLA provides other rules for intermittent and reduced leave schedules.  These rules address such topics as medical necessity, alternative position requirements, scheduling of the leave, determining the amount of leave used, and medical certification requirements.

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