FMLA Benefits Continuation & Health Insurance During FMLA Leave 1 — Questions and Answers
Question 1: Under FMLA, for how long must an employer maintain group health insurance coverage for an employee on approved FMLA leave?
- For the first 12 weeks of leave only, then COBRA applies
- For the entire duration of the FMLA leave period (Correct answer)
- For a maximum of 6 months from the leave start date
- Until the employee elects COBRA continuation coverage
Correct answer: For the entire duration of the FMLA leave period
Employers must maintain group health coverage for the full duration of an employee's FMLA leave under the same terms and conditions as if the employee had continued working.
Question 2: Before an employer may terminate health insurance coverage due to an employee's failure to pay premiums during FMLA leave, what must the employer provide?
- Immediate termination is permissible with no advance notice required
- At least 15 days' advance written notice before terminating coverage (Correct answer)
- At least 30 days' advance written notice per COBRA requirements
- Notice only if the employee is on unpaid leave
Correct answer: At least 15 days' advance written notice before terminating coverage
DOL regulations require employers to give at least 15 days' written notice before terminating health coverage for non-payment of premiums during FMLA leave.
Question 3: Which of the following best describes the 'same terms and conditions' standard for health benefit continuation during FMLA leave?
- The employee pays a higher administrative premium to offset leave costs
- Coverage is maintained at the same co-pays, deductibles, and premium contributions as active employees (Correct answer)
- The employer pays 100% of premiums during any unpaid FMLA leave
- The employee must elect COBRA and the employer subsidizes the cost
Correct answer: Coverage is maintained at the same co-pays, deductibles, and premium contributions as active employees
FMLA requires that health benefits be maintained on the same terms as if the employee had not taken leave, meaning no changes to co-pays, deductibles, or premium splits.
Question 4: An employee is on paid FMLA leave. How must their share of health insurance premiums be collected?
- Through the normal payroll deduction process from the paid leave wages (Correct answer)
- By direct payment from the employee to the insurance carrier
- Via COBRA election during the paid leave period
- The employer must absorb the employee's share during paid leave
Correct answer: Through the normal payroll deduction process from the paid leave wages
When an employee is receiving paid leave benefits, the employer may continue deducting the employee's premium share through the normal payroll process.
Question 5: If an employer offers dental and vision benefits in addition to medical insurance, what is the FMLA obligation regarding these supplemental benefits during leave?
- Only group medical health insurance must be continued; dental and vision may be suspended
- All group health benefits, including dental and vision, must be maintained under the same terms as for active employees (Correct answer)
- Dental and vision are governed solely by COBRA and not by FMLA continuation rules
- Supplemental benefits continue only if the employee pays the full premium cost
Correct answer: All group health benefits, including dental and vision, must be maintained under the same terms as for active employees
FMLA's benefit continuation requirement applies to all group health plan benefits, including dental and vision, not just medical insurance.
Question 6: What is an employer's obligation regarding group health plan benefits when an employee returns from FMLA leave?
- The employee must re-enroll during the next open enrollment period
- Benefits must be restored immediately upon return with no waiting period or requalification requirements (Correct answer)
- The employer has up to 30 days to reinstate benefits after the return date
- The employee may face a new pre-existing condition exclusion period upon reinstatement
Correct answer: Benefits must be restored immediately upon return with no waiting period or requalification requirements
Upon return from FMLA leave, an employee's group health benefits must be restored immediately without any waiting period, new enrollment forms, or requalification for coverage.
Question 7: An employer switches group health insurance carriers while an employee is on FMLA leave. What must the employer do?
- Provide the employee the option to remain on the prior carrier's plan
- Enroll the employee in the new plan under the same terms as active employees (Correct answer)
- Treat the plan change as a COBRA qualifying event for the absent employee
- Suspend benefit continuation until the employee returns and re-enrolls
Correct answer: Enroll the employee in the new plan under the same terms as active employees
When an employer changes group health plans during an employee's FMLA leave, the employee must be transitioned to the new plan under the same terms applicable to active employees.
FMLA Benefits Continuation & Health Insurance During FMLA Leave 1
Under FMLA, for how long must an employer maintain group health insurance coverage for an employee on approved FMLA leave?