Are Employers Required to Provide Health Insurance During Leaves of Absence?

employee benefit insurance

If employees decide to take leaves of absence that qualify, there are provided several layers of protection through the Family and Medical Leave Act (FMLA), and the Uniformed Services Employment and Reemployment Act (USERAA).

The most common of these types of protections is the fact that an employee is entitled to a similar job when they start working again. However, there are a number of other protections that are provided by law. For instance, several laws outline the duties of employers as to whether they are required to provide the employee with health insurance in the time of their absence. 

There are a few laws when it comes to FMLA, USERRA and laws in specific states when it comes to health insurance benefits that come from an employer. They look like this:

FMLA Regarding Employee’s Insurance

If an employee needs to take a leave of absence but still wants to be covered under employer health insurance, they must meet the following standards to qualify for FMLA: 

  • One full calendar year (12 months) of employment with the company (doesn’t have to be consecutive)
  • Work at least 1,250 hours within that one year
  • Maintain employment at a location that also employs at least 50 other workers, or within a radius of 75 miles
  • A qualifying reason for absence – a child, major health issues, or a family member being called to active duty in the military.

If an employee meets these criteria, it is required by FMLA law that employers continue their healthcare for the duration of their absence. If employers usually require a payment from their employees, this requirement also continues during their absence. The choice is up to the employer as to whether the payments are deducted from employee paychecks, or via advance payments by a personal check. If payments aren’t made on time by the employee the employer can terminate their healthcare. Small businesses who employ fewer than 50 employees are working within 75 miles of one workplace aren’t required to follow FMLA rules. 

USERRA Leave

If a leave of absence is less than 31 days, premiums are required to be paid as normal for both the employer and employee. If a leave of absence is more than 31 days, the whole cost of healthcare can be made the responsibility of the employee. Employees on USERRA leave usually get healthcare through the military, so they typically won’t decide to pay their coverage during their absence. Employers are still required to make group healthcare available, however. When an employee returns from a USERRA leave of absence, their group health care is required to be immediately reinstated, with no time periods of waiting. Each state has its own specific approved leaves of absences for continuing health insurance, state laws usually do require that employers provide health care if employees did not go on leave. Sometimes FMLA will conflict with the laws of a specific state. When this happens, employers are usually required to provide the employee with the most generous benefits. 

If you have any questions about employee leaves of absence, feel free to give us call here at Prodigy Stop Loss. We would be happy to answer your questions to help ensure that your employees are covered if the take leaves of absence. 

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