FMLA and Health Insurance: What You Need To Know

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Balancing work and family responsibilities while maintaining job security and health insurance benefits is a challenge that many employees, including federal employees and servicemembers, face. Thankfully, the Family and Medical Leave Act (FMLA), a federal law enacted in 1993 by the Department of Labor (DoL), is a cornerstone piece of legislation that addresses these challenges. It allows eligible employees, whether dealing with sickness or the needs of a spouse, kin, or loco parentis, to take up to 12 weeks of job-protected leave without pay (LWOP) per annum for specific family and medical reasons, and it requires that their group health benefits be maintained during the leave in case they get sick.

Understanding FMLA

The FMLA came into existence to help employees manage life transitions, such as parental leave, without the fear of losing their job or health insurance. It covers various qualifying situations, including becoming new parents, needing time off to care for a family member with a serious medical condition, or dealing with a serious health condition themselves that creates a period of incapacity where they can't work, attend school, or perform other key functions. Additionally, it addresses leaves related to military family member service and caring for a servicemember with an illness or injury incurred in active duty.

What is the Longest You Can Take FMLA?

While FMLA primarily offers up to 12 weeks of leave within a 12-month period, certain qualifying circumstances related to military family leave can extend this duration to 26 weeks. This extended provision underscores the need for employees, such as those with accrued sick leave or using paid family leave, to plan their leaves carefully and be aware of any potential impacts on their employment and benefits.

Scope and Types of FMLA Leave

FMLA leave is versatile and can be provided for various reasons such as the birth, adoption, or foster-care placement of a child; caring for an immediate family member with a serious medical condition; and when an employee, perhaps a caregiver, faces incapacity and is unable to work due to a serious medical condition. Furthermore, FMLA is adaptable to different needs, offering continuous, intermittently, or a reduced schedule, thus allowing for a block of time or sporadic time off depending on the individual's and employer’s needs.

Who is eligible for FMLA Leave?

Understanding eligibility is crucial for effectively utilizing FMLA. Employees must have worked for their employer for at least 12 months and clocked in 1,250 hours in the 12 months preceding the leave. Those who meet these requirements are entitled to avail of the benefits, including accrued leave, parental leave, and more. However, employers with fewer than 50 employees are exempt, and specific key employees may be ineligible for job protection upon return. A military servicemember or federal employee can be eligible for family medical leave too, and it's possible to start receiving benefits from short-term disability insurance while on FMLA leave. Note that the FMLA does not require employers to provide an employee leave to care for a same- or different-sex domestic partner.

What are the Rules Around FMLA?

Navigating the FMLA requires a clear understanding of its governing rules. Employees are required to provide a 30-day advance notice for foreseeable leaves, such as parental leave or paid family leave, and medical certification may be needed to substantiate the need for leave in case of illness (the employer must allow at least 15 calendar days to obtain the medical certification). Employers, in turn, have specific notice requirements to inform employees of their FMLA eligibility, rights, and responsibilities. Compliance with these rules ensures a smooth FMLA process and avoids unnecessary complications, especially when accrued leave is involved.

Guide to Completing FMLA Forms

Applying for FMLA involves a meticulous process where employees must complete several forms, including the FMLA certification of health care provider form, FMLA designation notice form, and FMLA reinstatement notice form. These forms are legal documents that must be filled out accurately and truthfully, as discrepancies can have serious repercussions, particularly for those on parental leave or paid family leave. Guidance on completing forms is available on the DoL website, and your human resource (HR) department can also help.

What's the Difference Between PFL/PFML and FMLA?

While FMLA is a well-known federal legislation offering unpaid leave, it’s essential to differentiate it from Paid Family Leave / Paid Family Medical Leave (PFL/PFML), a form of paid leave that showcases a stark contrast with the unpaid provisions of FMLA. The eligibility criteria, duration, and coverage under these two acts vary significantly, making it essential for employees, including servicemembers and their spouses, to understand the nuances of both to maximize benefits.

Health Insurance Benefits During FMLA Leave

A crucial aspect of FMLA is the continuation of health insurance benefits during the leave period, especially for those taking parental leave or dealing with an illness. Employers are obligated to maintain the employees’ health insurance benefits, ensuring that coverage is provided as if they had not taken leave. Employees, on the other hand, must continue to contribute their share of the premium, and failure to do so may result in a loss of coverage.

Responsibilities That Employees Have During Their FMLA Leave

While on FMLA leave, employees bear various responsibilities per DoL mandate. These include maintaining timely communication with their employers regarding the leave's status and any changes (typically 30 days or however soon is practicable), complying with employer policies, submitting periodic recertifications, and ensuring the continuation of health insurance premium payments. Those using accrued leave or paid leave must also keep track of their leave accrual and use it judiciously. These responsibilities highlight the importance of an ongoing commitment from both the employee and employer to maintain a balanced and equitable arrangement.

How Many Hours is 12 Weeks of FMLA?

For those contemplating intermittent leave or a reduced schedule, it’s pivotal to understand that 12 weeks of FMLA translate to 480 hours, based on a standard 40-hour workweek. This calculation helps in gauging the leave's impact on both professional commitments and personal life, particularly for those entitled to parental leave or paid family leave.

Potential Health Insurance Pitfalls during FMLA

Navigating FMLA leave can pose certain challenges, particularly regarding health insurance. The absence of regular payroll deductions can affect the employee's contributions, potentially jeopardizing coverage eligibility. Awareness and proactive financial planning, especially for those on paid leave or dealing with an illness, are key to averting such pitfalls.

Steps to Protect Health Coverage during Leave

To ensure the continuity of health coverage during FMLA leave, employees need to take several proactive steps. These include making timely premium payments, coordinating with employers, and maintaining detailed documentation regarding their health insurance benefits. Such measures help in avoiding any disruptions in health coverage during the leave period, especially for those using paid family leave or dealing with a serious illness.

Can I Leave My Job or give a 2 Week Notice While on FMLA?

FMLA does not require that you must return to your employment at the end of your leave of absence, or provide 2 weeks notice of not returning to the company. However, you may be immediately terminated if you provide 2 weeks notice.

What Happens When My 12 Weeks of FMLA is Exhausted?

Once the 12-week FMLA entitlement is exhausted, employees may find themselves without the protections offered by FMLA. However, exploring alternative options such as accrued paid time off, short-term disability benefits, or leveraging state-specific leave laws can offer additional support. Open communication with employers is essential to discuss potential accommodations or alternative arrangements in such scenarios, especially for those who have exhausted their parental leave or paid family leave benefits earned via accrual before their leave.

Importance and Impact of FMLA

The significance of FMLA is manifold. For employees, including those dealing with illness or taking parental leave, it offers peace of mind, enabling them to address personal and family needs without jeopardizing their employment or health coverage. For employers, FMLA helps in retaining experienced and committed staff, thus contributing to a more stable and productive workforce.

FMLA fosters a positive work-life balance and facilitates a harmonious working environment. It embodies a symbiotic relationship where mutual understanding, cooperation, and shared responsibilities between employers and employees lead to a supportive and inclusive workplace, benefiting both parties, including those on parental leave or paid family leave.


FMLA stands as a beacon of support for employees facing family and medical exigencies. It guarantees job protection, sustained health insurance benefits, and fosters a balanced, healthy, and productive workforce. Adherence to eligibility criteria, compliance with rules, accuracy in form completion, and proactive measures to maintain health coverage are paramount. The collaborative spirit of FMLA underscores its impact, benefiting employees, including servicemembers and their spouses, and contributing to a more inclusive and empathetic workplace culture.

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