[Code of Federal Regulations]

[Title 29, Volume 3]

[Revised as of July 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 29CFR825.212]



[Page 770]

 

                             TITLE 29--LABOR

 

         CHAPTER V--WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR

 

PART 825_THE FAMILY AND MEDICAL LEAVE ACT OF 1993--Table of Contents

 

 Subpart B_What Leave Is an Employee Entitled To Take Under the Family 

                         and Medical Leave Act?

 

Sec.  825.212  What are the consequences of an employee's failure to make 

timely health plan premium payments?



    (a)(1) In the absence of an established employer policy providing a 

longer grace period, an employer's obligations to maintain health 

insurance coverage cease under FMLA if an employee's premium payment is 

more than 30 days late. In order to drop the coverage for an employee 

whose premium payment is late, the employer must provide written notice 

to the employee that the payment has not been received. Such notice must 

be mailed to the employee at least 15 days before coverage is to cease, 

advising that coverage will be dropped on a specified date at least 15 

days after the date of the letter unless the payment has been received 

by that date. If the employer has established policies regarding other 

forms of unpaid leave that provide for the employer to cease coverage 

retroactively to the date the unpaid premium payment was due, the 

employer may drop the employee from coverage retroactively in accordance 

with that policy, provided the 15-day notice was given. In the absence 

of such a policy, coverage for the employee may be terminated at the end 

of the 30-day grace period, where the required 15-day notice has been 

provided.

    (2) An employer has no obligation regarding the maintenance of a 

health insurance policy which is not a ``group health plan.'' See Sec.  

825.209(a).

    (3) All other obligations of an employer under FMLA would continue; 

for example, the employer continues to have an obligation to reinstate 

an employee upon return from leave.

    (b) The employer may recover the employee's share of any premium 

payments missed by the employee for any FMLA leave period during which 

the employer maintains health coverage by paying the employee's share 

after the premium payment is missed.

    (c) If coverage lapses because an employee has not made required 

premium payments, upon the employee's return from FMLA leave the 

employer must still restore the employee to coverage/benefits equivalent 

to those the employee would have had if leave had not been taken and the 

premium payment(s) had not been missed, including family or dependent 

coverage. See Sec.  825.215(d)(1)-(5). In such case, an employee may not 

be required to meet any qualification requirements imposed by the plan, 

including any new preexisting condition waiting period, to wait for an 

open season, or to pass a medical examination to obtain reinstatement of 

coverage.