Can we ask an employee to pay their monthly portion for their health insurance while they are on disability?
Thank you for your inquiry regarding employee health benefits while the employee is out on leave for a disability.
The term “on disability” is a broad one that may encompass a variety of leave scenarios. For purposes of this inquiry we will assume that “on disability” means that the employee is out on a medical leave of absence and is also receiving supplemental benefits as part of an STD/LTD insurance plan.
We must then address whether the condition for which the employee is taking the leave of absence is a serious health condition that would qualify for protection (and concurrent leave) under the FMLA.
Specifically, if the employer is covered by and the employee is eligible for FMLA leave, then the employee is entitled to unpaid leave of up to 12 workweeks in a 12-month period for the employee’s own serious health condition that makes the employee unable to work at all or unable to perform any one or more of the essential functions of the position. (For more details on the FMLA, see the Leave of Absence topic page on HR.BLR.com).
Though the employee’s leave may be covered (and partially paid) pursuant to a short-term or long-term disability insurance plan, if the employee’s condition also qualifies for FMLA leave, then the employee is entitled to additional protections under those laws, including continuation of health benefits.
Specifically, the FMLA requires an employer to maintain health insurance coverage “at the same level and conditions of coverage that would have been provided had the employee not taken leave.”
Therefore, the employer may not ask the employee to contribute more to his or her health insurance premiums, but the employer may still expect the employee to cover the same portion of premiums that would be deducted from his or her pay if the employee were not on leave. For example, if employees on the group plan regularly contribute 20 percent of their premiums, then an employee on disability may be expected to continue to cover this 20 percent. However, the employee may not be required to pay more than this amount.
Additional, in-depth guidance and best practices on health benefit premium payment while an employee is on medical leave is available in this guidance document beginning on page 500-7.
If the employee has exhausted or does not qualify for leave under FMLA, then any benefit contributions must meet the ADA requirement that the employee be treated the same as any other employee on a comparable leave or part-time status. In this case, requiring the employee to continue covering his own premium contribution would be acceptable so long as the same would be required of other employees taking leave for reasons not related to a medical disability.