How do family leave policies affect my company's ability to pay for my benefits?
Quick Summary
It depends on whether you return to work after your leave. While your employer must maintain your health insurance coverage during your leave, they may be able to recover the premiums they paid for you if you do not return to your job for reasons other than your husband's ongoing health condition or other circumstances beyond your control.
The situation
I work as a full-time administrative assistant for a mid-sized manufacturing firm in Ohio. My company has about 150 employees. My husband was recently diagnosed with a serious health condition, and his doctor says he will need several weeks of recovery starting on October 15th. I am planning to take time off to care for him, but I am really worried about what happens to my health insurance and my paycheck while I am gone. I already spoke with my HR manager, Sarah, last Tuesday, and she mentioned that while we have some policies in place, she wasn't entirely sure how the company handles the costs of insurance premiums when someone is on extended leave. I want to know if there is any research or information available regarding how these types of leave policies actually impact the cost of employee benefits and whether employers are able to recover those insurance premium costs during the time an employee is away. I am specifically trying to figure out if my out-of-pocket costs for my dental and medical plans will spike or if the company's policy for temporary wage replacement will be affected by the overall cost of maintaining my benefits during my absence.
Detailed Analysis
Under the Family and Medical Leave Act (FMLA), your employer has specific obligations regarding your benefits while you care for your husband. Regarding your health insurance, the law states that "the employer shall maintain coverage under any 'group health plan'... for the duration of such leave at the level and under the conditions coverage would have been provided if the employee had continued in employment continuously for the duration of such leave"[1]. This means your medical and dental plans should stay active just as they were before your leave started on October 15th.
However, there is a rule about who pays for those premiums. While you are on unpaid leave, you are typically still responsible for your portion of the insurance costs. More importantly, the law allows for the recovery of the employer's portion under certain conditions. Specifically, "The employer may recover the premium that the employer paid for maintaining coverage... during any period of unpaid leave... if— (A) the employee fails to return from leave... and (B) the employee fails to return to work for a reason other than— (i) the continuation, recurrence, or onset of a serious health condition... or (ii) other circumstances beyond the control of the employee"[1].
In your case, if you take leave to care for your husband and then decide not to return to your position at the manufacturing firm for reasons unrelated to his health, Sarah (your HR manager) or the company could ask you to pay them back for the premiums they covered while you were away.
Regarding your paycheck, the law allows for "unpaid leave". This means your company is not required to pay your salary while you are gone, though you may be able to use accrued paid vacation or sick leave to receive income during this time. Whether your wage replacement is affected by benefit costs is not explicitly settled by these sections, but the law does note that the Commission is tasked with studying "the impact on employers and employees of policies that provide temporary wage replacement during periods of family and medical leave"[2].
Note that state or local laws in Ohio may provide additional protections or requirements regarding leave and benefits.
Statutory Citations
Legal Citation: Family and Medical Leave Act of 1993 § 29 U.S.C. § 2614 — Employment and benefits protection
"the employer shall maintain coverage under any “group health plan”... for the duration of such leave at the level and under the conditions coverage would have been provided if the employee had continued in employment continuously for the duration of such leave"View Official Legislation →
Legal Citation: Family and Medical Leave Act of 1993 § 29 U.S.C. § 2614 — Employment and benefits protection
"The employer may recover the premium that the employer paid for maintaining coverage... if— (A) the employee fails to return from leave... and (B) the employee fails to return to work for a reason other than..."View Official Legislation →
Legal Citation: Family and Medical Leave Act of 1993 § 29 U.S.C. § 2632 — Duties
"the impact on employers and employees of policies that provide temporary wage replacement during periods of family and medical leave"View Official Legislation →
Important Legal Disclaimer
General legal information, not formal legal advice. The information provided on LawAsked does not constitute formal legal advice and creates no attorney-client relationship. If you require legal assistance, please consult a licensed attorney in your jurisdiction.
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