Policy/Memo 87

Number: Policy Memo 87
Date Issued: April 16, 1996
Policy File Ref: A590

ISSUE:

Determine EBD obligation to offer health insurance at enrollee share for enrollees covered by the Family Medical Leave Act (FMLA).

Background:

FMLA mandates that individuals covered under this law be granted coverage equivalent to that of active employees and at the active employee premium rate. Several cases arose of persons on leave without pay who were canceled for non-payment and then had a FMLA qualifying event who asked to have health insurance under FMLA. The question was whether they could have coverage under FMLA since coverage had been canceled, and if they were so entitled, would there be a late enrollment waiting period.

Policy:

Coverage at enrollee share will be reactivated for the FMLA period if the enrollee had coverage in active status immediately prior to the leave period for which health insurance was canceled either voluntarily or for non-payment of premium. If coverage was not in effect during the active status that precedes the leave, employer paid coverage during the FMLA leave period will not be granted. Coverage will begin on the actual date of the start of FMLA leave, and the enrollee payments will begin based upon that date.

When coverage is reactivated for FMLA enrollees, whether during leave or upon their return to work, there will be no late enrollment waiting period.