Insurance Premium Payments While on FMLA

I have a pregnant employee who was advised very early in her pregnancy that she needs to be on full-time bed rest. She has missed 3 weeks of work and her return to work date has not been determined. Her FMLA request is pending due to lack of documentation from her physician (it is to follow they tell me). On July 13 I gave the employee the Physician's Certification form and I have not received it back - one month has passed and her FLMA request is still pending. Her short-term disability claim is in review and pending approval.

Each week her responsibility for insurance premiums is $70. Currently she owes $210. I've asked her three times to pay the balance due. She is asking if we can wait to receive payment. She's hoping her FMLA claim will be approved and she can apply some unused vacation pay towards her absence (she has only 1 week of vacation leave). She's also hoping her STD claim will be approved, providing income to pay the insurance premium. Thus far, the employee and her physicians have been slow to provide requested paperwork. I can't assume that anything is going to be approved until it is actually approved. Approval on FMLA and STD could take weeks. Therefore I hesitate to give her more time to pay the premiums. The more time that passes, the more money she will owe and the more difficult it will be to pay.

[U]My question is[/U] - what is the time frame that she must pay her portion of the insurance premium? My FMLA policy does not address this question. For how long do I leave her insurance intact if she's not making the payments? At what point do I tell her that she's in jeopardy of losing her insurance coverage if this drags on for more weeks? As of today she has missed 3 weeks and 1 day of work. Thanks!


  • 5 Comments sorted by Votes Date Added
  • First of all, I'd definitely recommend some changes to your FMLA policy and/or paperwork. You definitely need a clause stating the turnaround time for physician's certifications (DOL mandates at least 15 calendar days), and I would also add a clause about payment of premiums (DOL mandates at least 30 days to make payment, and I'd also add monthly due dates). If an employee fails to make timely payment, and you give them 30 days to make a missed payment, it is within your rights to cancel their insurance for non-payment, and when they return to work they'd be eligible just like a new employee to re-join the plan.

    Assuming you haven't given the employee a deadline, I would send them a "last chance" letter. The 15 required days for physician's certification have passed, so I would state something to the effect of, "we must receive your certification by Monday at 5pm, or your FMLA request will be denied due to insufficient information regarding your condition."

    For the premiums, you need to decide whether you want the premiums from her weekly, monthly, or some other schedule. I would calculate 30 days from the date of first missed payment, and tell her that's the deadline to pay. Failure to make payment by that day will result in termination of benefits.

    Good luck, and let us know how it goes!
  • Is the vacation time in question accrued or unaccrued? If it is accrued, I would recommend a change to your FMLA policy making paid leave concurrent with FMLA. As it is, there's nothing in the law to prevent you from paying her the vacation, whether FMLA has been approved or not, but the guidelines should definitely be part of your written policy.
  • Hi Frank.
    Thanks for your input, I appreciate your help! Our internal leave policy specifically states that an employee can not use accrued vacation leave if they are out for an illness or injury. We offer sick leave and personal leave for an illness or injury. The employee has used all of their sick and personal leave for 2010. We are not allowing her to use the vacation leave because of out internal policy. IF her FMLA is approved, FMLA guidelines would override our internal policy and we would allow her to apply her accrued vacation leave to her absence. Either way - the weeks are passing by and her FMLA form is not approved due to lack of physician certification.

    I'm going to send her a letter stating a hard deadline for the FMLA certification and a hard deadline to pay her insurance premuims. Hopefully that will inspire her.
  • I agree with Frank on this one. We allow our employees to use their vacation time when they have exhausted all of their sick leave. One idea behind this is they could take up to 12 weeks off work (FMLA) return to work and still have 2-3-4 weeks of vacation yet to take off that year. They are going to be paid for the vacation hours one way or the other, so why not go ahead and assist your employee in their time of need by allowing them to use the vacation hours when they are needed most – due to no income. At least this will help them to make their insurance payments.
  • Frank and Dutch are correct. If you are trying to keep employees from just calling in and using vacation when they are out of sick leave, I suggest you modify the policy to require all leave be used when on FMLA, but only when on FMLA. That way you still prevent employees from abusing their vacation leave by just calling in.

    The last thing you want is to have someone sue you for FMLA retaliation because you told them they couldn't take a week off for vacation when they just got back from 12 weeks off for FMLA.

    Good luck!
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