Or. Admin. Code § 101-030-0015 - Continuation of Core Benefit Coverage for Employees Covered under the Federal Family Medical Leave Act (FMLA) and the Oregon Family Leave Act (OFLA)
(1) Employees
taking approved FMLA or OFLA leave are entitled to the continuation of employer
provided health coverage. The agency is obligated to maintain the employee's
health coverage under the same conditions that would have applied had the
employee not been in leave.
(a) If the FMLA
or OFLA leave is substituted paid leave, then the employee's share of premiums
for continuation must be paid by payroll deduction.
(b) An agency may offer one or more of the
following options, to an employee who continues core benefit coverage while on
an unpaid FMLA or OFLA leave. Before commencing the leave, or shortly
thereafter, the employee and the agency must agree to one of the following
options for employee premium share.
(A)
Prepay. The employee is given the opportunity to prepay their premium share due
during the leave period before the leave begins. The prepay option cannot be
the sole option offered to employees on FMLA or OFLA leave.
(B) Pay as you go. The employee pays the cost
of coverage in installments during the leave. Contributions are paid with
after-tax dollars or with pre-tax dollars to the extent that the employee
receives compensation (e.g. unused sick or vacation days) during the
leave.
(C) Catch-up options. The
employer and employee agree in advance that the employer will advance payment
of the employee's share of the cost of coverage during the leave and that the
employee will repay the advanced amounts when the employee returns to
work.
(D) Revoke Coverage.
Employees may revoke the employer offered core health coverages during the
leave. In this event the agency sends a COBRA notice of availability.
(2) Employees enrolled
as Opt Out, receiving cash in lieu of medical benefits, do not receive the
monthly payment when in leave without pay status, regardless of approved FMLA
or OFLA leave.
(3) An employer is
not required to continue the benefits of an employee who fails to make required
payments while on FMLA or OFLA leave provided notice procedures are followed.
Refer to OAR 101-020-0002(7)(d) for employee non-payment notices and benefit
termination. If the employer chooses to continue the health coverage of an
employee who fails to pay his or her share of the premium payments the employer
is permitted to recoup the employee's premium.
(4) A Health Care FSA is a group health plan
under FMLA or OFLA. Refer to OAR 101-020-0065(9) regarding required payment
options during a FMLA or OFLA leave. Prepayment cannot be the only method
offered for FSA continuation during FMLA or OFLA leaves.
(5) An eligible employee may continue the
following optional plans during the approved FMLA or OFLA leave by self-paying
premiums or contributions to the agency:
(a)
All Optional Life Insurances:
(b)
Short Term and Long Term Disability,
(c) Accidental Death and Dismemberment
Insurance:
(d) Long Term
Care
(6) An agency must
provide a benefit eligible employee who is in FMLA or OFLA leave during the
annual open enrollment period the opportunity to select benefits for the coming
plan year.
(7) An employee
returning to paid regular status the first day following the end of an approved
FMLA or OFLA leave or as scheduled, or an employee in a current benefit
eligible stability period is not required to work at least half-time in the
month of return to be eligible for benefits the following month. Core benefits
and optional coverages are reinstated if available retroactive to the first day
of the month that the employee returns to work.
(a) The employee must self-pay premiums for
optional insurance plan reinstatements for the month in which they
return.
(b) An employee returning
to work will not be reinstated in Long Term Care unless the employee had
continued the coverage by self-paying premiums during the leave.
(c) An employee's FSA enrollment status,
active or terminated, will depend on the employee's FSA continuation status
during the leave. If the employee's FSA enrollment terminated during the leave
the employee may enroll.
(8) An employee that waives all coverages for
the leave period and returns to paid regular status beyond 30 days of loss of
coverage but within 12 months from the loss of coverage, is reinstated to
coverage and can make midyear plan changes within 30 days of the date they
return to work. This includes enrollment for a FSA account or long term
care.
(9) An employee who does not
return to paid regular status the first work day immediately following the end
of approved FMLA or OFLA leave as scheduled, and is not in a current benefit
eligible stability period is considered the same as if returning from an
unprotected leave without pay. The employee is required to work at least half
time 80 hours in the month of return to receive reinstated benefits the
following month. See OAR 101-020-0045(2)(a).
(10) A COBRA qualifying event occurs when (i)
the employee does not return to work as scheduled the first day after the
qualified leave ends and is not in a current stability status, or (ii) the
employee terminates employment.
Notes
Stat. Auth.: ORS 243.061 - 302
Stats. Implemented: ORS 243.061 - 302, 659.A150 - 186
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