FMLA Benefits Continuation & Health Insurance During FMLA Leave 2 — Questions and Answers
Question 1: Under what primary circumstance may an employer recover health insurance premiums it paid during an employee's FMLA leave?
- Whenever the employee voluntarily resigns within 90 days of returning from leave
- When the employee fails to return to work after FMLA leave, unless failure is due to a continuing serious health condition or circumstances beyond the employee's control (Correct answer)
- Any time the employee takes more than one FMLA leave in a 12-month period
- When the employer determines the leave was taken for an ineligible reason
Correct answer: When the employee fails to return to work after FMLA leave, unless failure is due to a continuing serious health condition or circumstances beyond the employee's control
Employers may recover the premiums they paid during FMLA leave only when an employee fails to return, and only if that failure is not caused by a continuing serious health condition or a circumstance beyond the employee's control.
Question 2: When an employee is on unpaid FMLA leave, which of the following describes a permissible employer arrangement for collecting the employee's premium share?
- The employer must pay the full premium and seek reimbursement only after the employee returns
- The employer may require the employee to pay via prepayment before leave, pay-as-you-go during leave, or catch-up payment upon return (Correct answer)
- The employer may automatically enroll the employee in COBRA to handle premium collection
- The employer may suspend coverage and reinstate it upon return to simplify administration
Correct answer: The employer may require the employee to pay via prepayment before leave, pay-as-you-go during leave, or catch-up payment upon return
DOL regulations permit three acceptable methods for collecting employee premiums during unpaid FMLA leave: prepayment before leave begins, payment during leave, or catch-up upon return.
Question 3: If an employer recovers health insurance premiums after an employee fails to return from FMLA leave, which portion of premiums may the employer legally recover?
- The total insurance cost including both the employer and employee shares
- Only the employee's share of premiums that went unpaid during leave
- The employer's share of premiums paid on behalf of the employee during FMLA leave (Correct answer)
- Six months of the combined premium regardless of actual leave duration
Correct answer: The employer's share of premiums paid on behalf of the employee during FMLA leave
The employer may only recover its own share of health insurance premiums paid during the FMLA leave period, not the total premium or the employee's contribution.
Question 4: An employee notifies their employer mid-leave that they do not intend to return to work. When may the employer begin seeking recovery of paid premiums?
- Immediately upon written notification from the employee of intent not to return (Correct answer)
- Only after the originally scheduled FMLA leave end date has passed
- After 30 days from the date of notification as a grace period
- Only after a formal separation agreement has been signed by both parties
Correct answer: Immediately upon written notification from the employee of intent not to return
Once an employee affirmatively states they will not return, the employer may treat the leave as ended and initiate premium recovery, subject to the exceptions for circumstances beyond the employee's control.
Question 5: If an employee's absence extends beyond the 12-week FMLA entitlement, what happens to the employer's group health insurance continuation obligation under FMLA?
- The employer must continue FMLA health coverage for up to 26 weeks for military caregiver leave situations
- FMLA benefit continuation requirements no longer apply once FMLA leave is exhausted; other laws such as COBRA or the ADA may govern (Correct answer)
- The employer must maintain coverage for an additional 12 weeks beyond the FMLA period
- The employee automatically qualifies for a guaranteed-issue special enrollment period
Correct answer: FMLA benefit continuation requirements no longer apply once FMLA leave is exhausted; other laws such as COBRA or the ADA may govern
FMLA's benefit continuation obligation ends when FMLA leave is exhausted; the employer's obligations after that point are governed by other applicable laws such as COBRA, the ADA, or state laws.
Question 6: An employer designates an employee as a 'key employee' and intends to deny reinstatement. What is the employer's obligation regarding health benefits during the FMLA leave?
- The employer may suspend health benefits immediately upon providing the key employee notice
- The employer must still maintain group health benefits during the FMLA leave period, even if reinstatement may ultimately be denied (Correct answer)
- Key employee status eliminates all FMLA benefit continuation obligations
- The key employee must elect COBRA from the very start of the leave period
Correct answer: The employer must still maintain group health benefits during the FMLA leave period, even if reinstatement may ultimately be denied
Even when an employer notifies a key employee that reinstatement may be denied, the employer must still maintain group health coverage for the duration of the FMLA leave.
Question 7: Which agency within the Department of Labor primarily enforces the health benefit continuation requirements under FMLA?
- The Centers for Medicare & Medicaid Services (CMS)
- The Employee Benefits Security Administration (EBSA)
- The Equal Employment Opportunity Commission (EEOC)
- The Wage and Hour Division (WHD) (Correct answer)
Correct answer: The Wage and Hour Division (WHD)
The Wage and Hour Division (WHD) of the DOL has primary enforcement authority over FMLA, including benefit continuation requirements, while EBSA oversees ERISA compliance for benefit plans.
FMLA Benefits Continuation & Health Insurance During FMLA Leave 2
Under what primary circumstance may an employer recover health insurance premiums it paid during an employee's FMLA leave?