who is responsible to pay the health and dental insuance while on maternity leave?

[kackerley]

I live in NY and just returned to work from maternity leave. I received Short term disability for 6 weeks but was out for 13. I asked my employer who would be responsible for my health insurance while I was out and he told me that they would take care of it and that was the end of the discussion until last week my employer told me that I needed to pay for my portion of my health and dental that they paid while I was out. I questioned it and now I don't think they have a clue. I am the first person to ever go one maternity leave here. Also in our policy mannual it says nothing about FMLA only Unpaid leave and that states they will pay only their portion of health and dental for a period of less than one month. I think from what I have read this is in violation of the FMLA Act. So I guess my question is who is responsible to pay the health and dental insuance?

 

[ecmst12]

Do you qualify for FMLA? For FMLA to apply, you need to have been employed for at least 12 months, have worked at least 1250 hours in the past 12 months, and the company must have at least 50 employees within 75 miles of your location. If ALL of those conditions are not met, then you do not qualify for FMLA and they can charge you for premiums paid on your behalf during unpaid leave.

 

[Zigner]

Even under FMLA, one is required to pay for the portion of the insurance that they would normally have paid for if they had been at work...

 

[justalayman]

In support of Zigner's post.

from the DOL:

Maintenance of Health Benefits

A covered employer is required to maintain group health insurance coverage, including family coverage, for an employee on FMLA leave on the same terms as if the employee continued to work.

Where appropriate, arrangements will need to be made for employees taking unpaid FMLA leave to pay their share of health insurance premiums. For example, if the group health plan involves co-payments by the employer and the employee, an employee on unpaid FMLA leave must make arrangements to pay his or her normal portion of the insurance premiums to maintain insurance coverage, as must the employer. Such payments may be made under any arrangement voluntarily agreed to by the employer and employee.

An employer's obligation to maintain health benefits under FMLA stops if and when an employee informs the employer of an intent not to return to work at the end of the leave period, or if the employee fails to return to work when the FMLA leave entitlement is exhausted. The employer's obligation also stops if the employee's premium payment is more than 30 days late and the employer has given the employee written notice at least 15 days in advance advising that coverage will cease if payment is not received.

In some circumstances, the employer may recover premiums it paid to maintain health insurance coverage for an employee who fails to return to work from FMLA leave.

Now, you do realize you were out for 13 weeks so after 12, nothing in the FMLA applies. The insurance would become a matter of COBRA continuation if the employer does not want to maintain you on their insurance roles at their expense. In any case, you if they do not want to pay even their portion to maintian you on the insuracne roles, they could allow you to pay both your share and their share. At this point, they didn;t even have to allow you to return due to the excess of 12 weeks time off.

So, you owe for your share during the 12 week FMLA period. You would owe for your share of the 13 week and if they want you to pay their share, you owe for that as well.

or; they could simply terminate you if that sounds better.

 

[kackerley]

I do qualify with out a doubt for FMLA. I have been working here for 7 years as a full time employee. I know I was out for 13 weeks but my employer granted unpaid leave until a certain date and my leave started early because my son was 2 weeks early and my doctor took me out one week before that. What about the law that gives you the right to take up to a year off to care for your new baby? How does the insurances work with that?

 

[ecmst12]

I'm not aware of any law in this country that would allow you to take a full year off. Maybe you are thinking of Canada? FMLA is good for 12 weeks, on the first day after 12 weeks were up, they could have legally terminated your employment. They could certainly charge you the full premium (including employer portion) for the 13th week. And you are of COURSE responsible for your normal employee contribution for the entire time you were out.

 

[cbg]

Nowhere in the US are you entitled to a full year off when you have a baby. Some women in California, depending on a variety of circumstances, may be eligible for up to 7 months but not all California women will so qualify. In a handful of other states, state law may grant up to as much as 24 weeks. In most states, 12 weeks is the maximum protected by law.

What you may be thinking of is that bonding time, which is whatever is left over of the 12 weeks after you are cleared to return to work, can be taken at any time up to a year. But a full year off guaranteed? Not in these United States.

As far as the premiums go, for the time you are on FMLA you are responsible to pay the same amount that you would be paying if you were at work. The employer likewise pays the same amount that they would pay if you were working. If you CHOOSE not to return to work, the employer can legally require that you repay the share that they paid. If you are medically unable to return to work, the employer cannot charge you for the premiums they paid but they have no further legal obligation to pay any more, either. Once FMLA ends, if you do not return to work for any reason (voluntarily or involuntarily) it is up to the employer whether to continue paying anything towards your insurance. If they choose to put you on COBRA and have you pay the full amount, the law is not going to tell them they can't.

 

[DaveT]

If you CHOOSE not to return to work, the employer can legally require that you repay the share that they paid.

Is this something you know from previous experience or is there a website where I can find information on this law? I don't doubt your claim; I'm just looking for more detail and anything specific to NJ.

My wife is due in September and hasn't decided whether she will continue working full time, part time, or not at all, so we're looking for all the information we can get to help make our decision.

Thanks!

 

[cbg]

That is a Federal law, covering all states including NJ, and is written into the FMLA statute.