Mastering the FMLA: 4 steps for dropping health care coverage for non-payment
Employers must maintain group health coverage while employees are on leave under the federal Family and Medical Leave Act (FMLA). Employers may, however, require employees to pay their share of the premiums. Sometimes, though, employees fail to pay their share.
Employees must continue to pay their portion of group health plan premiums during FMLA leave on the same basis they had been paying before FMLA leave began. If the plan raises or lowers premiums, employees pay the new premium rates.
If employees fail to make their payments, employers may drop them from coverage, but not without some forethought.
4 steps needed before dropping coverage
Before dropping employees on FMLA leave from group health care coverage because they failed to pay their share of the premiums, employers need to take certain steps:
- Inform employees. Review the communications made to employees to ensure they’re informed of the payment requirements and consequences.
- Check policy grace periods. If the group health policy does not provide a longer grace period, employer obligations to maintain health insurance coverage cease under the FMLA if employees’ premium payment is more than 30 days late. Otherwise, employers must follow their plan documents regarding a grace period.
- Create written employee notice. In order to drop the coverage for employees whose premium payments are late, employers must provide written notice to the employees about not receiving payments. The FMLA does not provide a model notice for this, so employers must come up with their own.
- Mail notices in time. Employers must mail notices to employees at least 15 days before coverage is to cease, advising that they will drop coverage on a specified date at least 15 days after the date of the letter unless they receive payment by that date.
Ceasing coverage retroactively
If employers have established policies regarding other forms of unpaid leave that allow them to cease coverage retroactively to the date the unpaid premium payment was due, they may drop employees from coverage retroactively in accordance with that policy, provided they give the 15-day notice.
Without such a policy, employers may cease coverage for employees at the end of the 30-day grace period, as long as they provided the required 15-day notice.
When employees return
If employers drop coverage because employees did not make premium payments, upon their return from FMLA leave, employers must still restore them to coverage/benefits equivalent to those they would have had if they had not taken leave and they had not missed the premium payment(s), including family or dependent coverage.
Key to remember: Employers may drop employees from group health care coverage for failing to make premium payments during FMLA leave, but not before taking some steps.