Benefits, Leave Policy/Compliance

Ask the Expert: Benefits Continuation during Leave of Absence?

If an employee was approved to take an unpaid month long leave of absence, are we required to extend her health benefits during that month? If we are obligated to provide them, is she responsible for the entire premium for that month? Do we treat this like a continuation of coverage, even though she is still employed?

Thank you for your question about benefits continuation during a leave of absence. The answer to your question turns in large part on why the employee is looking to take a month off from work.

If the employee is taking a leave that may be eligible under the federal FMLA, the employer must determine eligibility and designate the leave. Under the FMLA, employers are required to maintain healthcare coverage for employees during leave under a group health plan at the same level and conditions of coverage that would have been provided had the employees not taken leave. During the leave period, the employer and employee continue to pay their usual respective portions of the premium.

If she is suffering from a health condition that could qualify for accommodation under the Americans with Disabilities Act (ADA), then you would have to provide any benefits to the employee that you provide to other similarly situated employees–i.e., employees who are out on non-ADA leaves.

If the leave is pregnancy-related, under federal law, you must provide the same leave benefits to women affected by pregnancy that you provide to employees with temporary disabilities. The leave offered may be with or without pay/benefits, or not provided at all, as long as all employees are treated the same in their requests for temporary disability leave.

Federal law does not require employers to provide healthcare insurance for employees. If insurance is offered, however, it must cover expenses for pregnancy-related conditions on the same basis as for other medical conditions (with the exception of abortion). As with other fringe benefits, employers who offer employees health insurance must include coverage of pregnancy, childbirth, and related medical conditions.