Long-Term Disability and Health Benefits

Cindy Davis

If a company has a long-term disability policy that starts 90 days after the initial disability, do you still pay the health benefits? The first three months of benefits can be paid by the employer because of FMLA, but what happens after that? Is it dependent on the terms of the disability policy? Does the employee pay for health benefits after the 12 weeks of FMLA? Is it whatever the company policy is?

Margaret Morford

Look first at what your LTD policy says. If it's silent, then you go to your company policy. What do you do when anyone is out on any type of LOA? Do you have a policy that limits how long anyone can be off work on leave before they are terminated? Many companies have this clause and set the time at 6 months, with a review by HR to make sure that a reasonable accomodation of an extension at the end of 6 months might not be necessary.

Margaret Morford
theHRedge
615-371-8200
[email]mmorford@mleesmith.com[/email]
[url]http://www.thehredge.net[/url]

njjel

We have someone who may be out beyong six months and I'm wondering what would your definition be of a "reasonable accommodation" after a six month leave?

Margaret Morford

There's no hard and fast definition for what would be reasonable after you've already allowed 6 months. If the employee's doctor says they only need two more weeks before they can return, I think the EEOC and the courts would say it's reasonable to hold the job two more weeks. If the doctor cannot tell you when the employee will be able to return, I'd terminate at six months.

Margaret Morford
theHRedge
615-371-8200
[email]mmorford@mleesmith.com[/email]
[url]http://www.thehredge.net[/url]

Lori B

Take a careful look at your health insurance contract. Most carriers require that ees be "actively at work" to be covered under a group health plan. They allow an exception for up to 12 weeks to correspond to FMLA leaves. If you continue to carry someone on your health plan after 12 weeks like this, it raises a potential fraud claim against you. The carrier could make things nasty for you if you never alert them of the reduced hours. If you are self insured, perhaps you already addressed this in your plan document to provide for more flexibility. If you are fully insured, I'd bet money that your contract has the 12 week leave option only.

We force everyone into COBRA (regardless of the reason for leave) once they are out for 12 weeks or more.

E Wart

[font size="1" color="#FF0000"]LAST EDITED ON 08-22-02 AT 07:36AM (CST)[/font][p]I think you have several issues involved here. First you bring up FMLA which is holding the job open and making group insurance available as before. However, it looked to me like your question had to do with who pays the group insurance after the 90 days/12 weeks leave.
First, who paid the premiums when the employee was actively at work? (100% co or some split between employee and company.)
Secondly, What is your Company policy for length of absence? (Some companies say 6 months and you are terminated whether or not you are still LTD or not, some say a year, some don't say at all.)
Thirdly and most importantly, what does your group insurance contract say. The length of time a person is eligible for this (much less who pays it) is controlled by this contract not LTD.
Lastly, I think most contracts allow employee to pay at the rate they were paying as active employee as long as on qualified leave of absence (if they allow it after the 12 weeks) unless they don't allow it at all. It becomes a different question if the person takes a leave of absence for some other reason (i.e. to go back to school or take an extended trip or something else). Again your group insurance plan should cover all of this. Also, you may want to look at some of your Company's policies.
EWart of GA