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medical insurance when on LTD

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desperate_1

Junior Member
What is the name of your state (TX)?

My husband is diagnosed with cancer, exhausted his FMLA and will start long term disability soon. Technically his employment will terminate when LTD starts. The question is whether we have to switch to COBRA at that time or there is a law stating that employee can receive same benefit coverage (including medical) while on LTD? My employer has that specific term: former employee on LTD are still treated as employee for benefit purpose. But his employer did not provide any written policy regarding the situation. Is it totally up to the employer what they want to do?

Thanks.
 


cbg

I'm a Northern Girl
No, there is no law guaranteeing coverage from the employer, other than COBRA, while collecting any kind of disabilty benefits. In 45 states, including yours, there is not even a law requiring disabilty benefits. In actual fact, as soon as his FMLA expired, his employer was under no legal obligation to continue to provide health insurance other than COBRA, regardless of his employment status or the status of his disability benefits. Once FMLA expires, it is entirely up to what it says in the plan document as to eligibility. If the plan document says that once LTD starts, your employment ends, then once LTD starts, COBRA is your only option unless a legally binding contract or CBA expressly says otherwise, or the plan document expressly provides for additional coverage in those circumstances.

I believe that in Texas, health insurance must continue until the last day of the month in which employment ends (for any reason, not just medical leave). That's about as good as it's going to get.

Sorry, I know this is not the answer you want.
 

desperate_1

Junior Member
Thanks, Cbg.

Talked to his HR again today. The thing I am confused about is that his HR suggested that he start FMLA for 90 days (which is almost over by now) and then apply for leave of absence for another 90 days (so that his employment is still active during that period). And at the end of LOA, apply for LTD. Once LTD starts, his employment terminates. We have not started LTD application ,and during his FMLA and LOA, he does not even get paid. I know the clearance period for LTD is 90 days, but why it has to be tied with FMLA and LOA? Now if we wait for another 90 days on LOA without payment, will we be able to collect LTD on those 90 days later on?

Thanks for your advice.


No, there is no law guaranteeing coverage from the employer, other than COBRA, while collecting any kind of disabilty benefits. In 45 states, including yours, there is not even a law requiring disabilty benefits. In actual fact, as soon as his FMLA expired, his employer was under no legal obligation to continue to provide health insurance other than COBRA, regardless of his employment status or the status of his disability benefits. Once FMLA expires, it is entirely up to what it says in the plan document as to eligibility. If the plan document says that once LTD starts, your employment ends, then once LTD starts, COBRA is your only option unless a legally binding contract or CBA expressly says otherwise, or the plan document expressly provides for additional coverage in those circumstances.

I believe that in Texas, health insurance must continue until the last day of the month in which employment ends (for any reason, not just medical leave). That's about as good as it's going to get.

Sorry, I know this is not the answer you want.
 

cbg

I'm a Northern Girl
I can tell you what the LAW says.

The LAW says that as long as he is on FMLA, which lasts for 12 weeks ONLY unless a state law specifically says it is longer (and there is no such state law in Texas), the employer has to leave his health insurance in force under the same conditions as if he were working. The LAW does not make any provisions to continue coverage on a non-FMLA LOA, or, for that matter, any other LOA. If it's not FMLA, the employer policies and the terms of the plan document rule.

There is nothing in the LAW that determines when the LTD policy is payable. In 45 out of 50 states, including Texas, there is no LAW that there be an LTD policy at all.

I cannot tell you what the company policy says, or what the LTD policy says, or when the LTD policy is payable. Those are not directed by law; they are directed by the plan documents and the company policies.
 

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