Health Insurance Rights During Medical Work Leave

DMS Blog1Many individuals wonder what is going to happen to their employer-sponsored health insurance coverage while they are on a medical leave of absence from work. As with most legal questions, the answer is it depends.

This post addresses some of the initial factors you might consider in determining whether your health insurance coverage will continue while you are unable to work.

Reading: Who pays health insurance while on short term disability

Your health insurance should continue if you are on fmla leave

The Family and Medical Leave Act (FMLA) allows workers to take up to 12 weeks of unpaid medical leave in a year for a serious health condition without losing their job. Whether you’re eligible for fmla leave depends on a number of factors, including the number of employees at your business, how long you’ve worked for the business, and whether you’ve had any other medical leave in the last year. You can find more information about fmla here.

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if you have health insurance with your employer and take fmla leave, then the employer must continue your health insurance coverage on the same terms as if you had continued working. that means if you had done contributions to health insurance premiums, you will still be required to do so. If premiums were normally deducted from your paycheck, but your leave is not paid, you will need to arrange to pay the employee portion of the premiums to maintain coverage.

A note of caution: If you do not return to work at the end of your leave period, or if you inform your employer of your intention not to return, the employer is no longer required to maintain your health insurance benefits. In addition, the employer may require him to repay the employer’s portion of the premium payments if he does not return to work after the leave.

some employers offer continuous health insurance while employees are approved for short-term or long-term disability insurance benefits

Although not required, some employers offer continuous health insurance coverage while a worker is on short-term or long-term disability leave. short-term and long-term disability benefits do not cover the cost of health insurance premiums. rather, std and ltd policies pay a percentage of your earnings while you are unable to work. To determine if you will have continued health insurance coverage while on short-term or long-term disability leave, you will need to review your employer’s policies and/or benefits manual. An employer is not required to maintain an employee’s health insurance coverage for extended leaves of absence, but is required to follow its written policies and apply them consistently.

in most cases, you should be allowed to elect cobra continuation coverage if you lose your health insurance

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Other than certain small employers, as well as the federal government and church organizations, employers must allow you to elect Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation coverage if your health insurance coverage ends because of your permission absence from work. Generally, for health insurance losses due to leaves of absence, you will be entitled to 18 months of continuous collectible coverage.

Assuming the leave causes you to lose your health insurance, your employer must notify the group health plan within 30 days of the qualifying event. Within 14 days of receiving the notice, the group health plan must send you an election notice informing you of your rights to elect Cobra continuation coverage. then you must be allowed at least 60 days to choose whether or not to elect the coverage you charge.

Despite the availability of cobra continuation coverage, many people do not choose cobra health insurance because it can be expensive. That’s because your group health plan may legally require you to pay up to 102 percent of your total cost in premiums.

As described above, there are various laws and policies to consider in determining whether your health insurance benefits will continue while you are on medical leave. If you would like to discuss your rights to continued health insurance, contact Quindel Hawks to arrange a consultation with an employee benefits attorney.

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