BENEFITS CONTINUATION WHILE ON

APPROVED LEAVE OF ABSENCE

Maricopa CountyEmployee Benefits and Wellness Division

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Agenda

Policy and Definitions Reporting Benefits Continuation Tracking Potential Termination Notices Termination of Benefits Returning to Work Termination of Employment Roles and Responsibilities Examples

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Policy and Definitions Policy:

*In a rolling 12-month period from initial approved LOA

Employee is responsible for the Employee Only portion of the premiums

Active benefits terminate the last day of the month in which the maximum period of benefits continuation has been met

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Policy and Definitions

The Benefits Continuation policy does not change the leave policy

The Benefits Continuation policy does not change payroll processing

The Benefits Continuation policy allows consistence in benefits administration, ensures accuracy, and manages costs for the employees and the Plan

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Policy and Definitions

Definition of Non-Pay Status:Non-Pay Status is defined as not having sufficient earnings from which to deduct the Employee Portion of the premiums for benefits in which an employee is enrolled. May include: Medical, Prescription, Behavioral Health Vision Dental Additional Life and Additional AD&D Spouse Life Child Life Short-Term Disability Flexible Spending Accounts Group Legal

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Reporting Each pay period, the Employee Benefits and Wellness

Division works reports that include employees who are in a non-pay status who are:

• Active• Non-FMLA• FMLA• Military

Employees listed on the reports will be tracked accordingly and monitored for updates to their record in EV5

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Benefits Continuation Tracking For proper Benefits Continuation Tracking, the department liaison

must submit a PAF to Employee Records within 2 business days of approving a leave of absence• The department liaison must take action to ensure benefits are not

terminated prematurely• Notification is sent to the employee’s department liaison via email when

an employee is in Active status and unpaid for 2 consecutive pay periods

For employees on approved Military LOA, the department liaison must submit a PAF to Employee Records along with a copy of the Military Orders and the Employer Notification of Uniformed Service Form. These documents must also be submitted to the Employee Benefits and Wellness Division within 30 days so we may administer benefits according to the employee’s request

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Benefits Continuation Tracking Once PAF received by Employee Records, they will update EV5

Employee Benefits and Wellness Division will administer the benefits accordingly as reflected by the employees status in EV5• 4 unpaid pay periods under approved Non-FMLA status• The duration of the approved FMLA period while in unpaid status• 12 months for approved Military Leave while in unpaid status• Change in leave status (i.e. from approved FMLA to approved Non-FMLA)

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Potential Termination Notices

Potential Termination Notices can be:• Emailed to the department liaison when an employee is

in a non-pay status and reflecting as Active in EV5• Mailed in the form of a letter to an employee who is

close to reaching the maximum benefits continuation timeframe– For Non-FMLA when the employee has reached 2 of 4 unpaid

pay periods– For FMLA when the employee has reached 4 of 6 unpaid pay

periods– For Military Leave when the employee has reached 22 of 24

unpaid pay periods

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Potential Termination Notices

Sample Trigger Notification emailed to department liaison:

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Potential Termination Notices Sample letter mailed to employee:

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Termination of Benefits Once an employee has reached the maximum benefits

continuation timeframe, benefits termination occurs and COBRA packet is mailed to the employee

All active benefits in which the employee was enrolled terminate the last day of the month in which the maximum timeframe was reached

Employee Benefits and Wellness Division does verify record prior to processing termination to confirm that the employee has not returned to work or changed approved leave status as reflected in EV5

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Termination of Benefits Consequences of benefits termination include:

• The Benefit Enrollment System reflects terminated for employee and all covered dependents

• Vendors are notified of benefits termination• COBRA Notice is mailed• Benefit premium arrears go into collections• Employee is financially responsible for claims incurred

after loss of coverage• Employee must explore other options for obtaining

coverage

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Returning to Work When an employee returns to work after an unpaid LOA,

notification should be made to the Employee Benefits and Wellness Division

A PAF must be submitted to Employee Records within 2 business days of the employee returning from LOA

If returning to work prior to the maximum benefits continuation timeframe, benefits will continue without interruption and benefit premium arrears are paid by employee via payroll

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Returning to Work If returning to work after active benefits have been

terminated, the employee must contact the Employee Benefits and Wellness Division within 30 calendar days• Employee elects benefits by completing a Status Change

Form• PAF must be submitted to Employee Records so that EV5

is updated to Return from Leave status to proceed with benefits reinstatement

• Outside the 30 day window, only Basic Life and Basic AD&D are reinstated and employee will need to wait for Open Enrollment to make elections again

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Termination of Employment

If employment terminates prior to exhausting the benefits continuation timeframe, the tracking process will end and active benefits will terminate the last day of the month in which employment ends• The former employee will be mailed a COBRA

notice• The former employee will be invoiced for the

employee only portion of the benefit premiums they were unable to pay while in the unpaid status

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Roles and Responsibilities Submit PAFs to Employee Records within 2 business days of

the start of the employee’s approved LOA• A separate PAF is required for each type of leave

Remind employees to contact the Employee Benefits and Wellness Division:• Within 30 calendar days of their return to work date• For questions regarding benefit premium arrears/process• For questions regarding the Benefits Continuation policy

Take action immediately upon receiving notifications from the Employee Benefits and Wellness Division

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Examples

The following are examples of how the process works when an employee’s record in EV5 is up to date with the appropriate leave status

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ExamplesNon-FMLA Scenario Employee is approved for a 1-month personal LOA for

education purposes Employee has enough vacation leave hours accrued to

cover the personal LOA period

Answer Benefits will remain active Benefit premiums will continue to be deducted from

employee’s paycheck

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ExamplesNon-FMLA Scenario Employee is approved for a 3-month unpaid LOA for medical

reasons Employee does not have sick or vacation leave hours

accrued to cover the LOA period

Answer Benefits will be terminated the last day of the month after

the employee has been in a non-pay status for 4 pay periods (in a rolling 12-month period)

Employee responsible for paying benefit premiums at active employee rates for time period before benefits terminated

COBRA coverage available

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ExamplesFMLA Scenario Employee is approved for FMLA Employee returns to work after being released and prior to

exhaustion of available FMLA hours

Answer Benefits will continue without interruption Employee responsible for paying benefit premiums at active

employee rates for time on leave without pay

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ExamplesFMLA Scenario Employee is approved for FMLA Employee does not return to work after exhaustion of

available FMLA hours

Answer Benefits will be terminated after FMLA period ends unless a

new PAF has been submitted to Employee Records reflecting that employee is approved for different leave type

Employee responsible for paying benefit premiums at active employee rates for time period before benefits terminated

COBRA coverage available

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ExamplesMilitary Leave Scenario Employee is approved for Military Leave Employee elects to continue enrollment in the County’s

group health benefits Employee returns to wok within 12 months of Military Leave

commencement date

Answer Benefits will remain active Employee responsible for paying benefit premiums at active

employee rates for time on leave without pay

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ExamplesMilitary Leave Scenario Employee is approved for Military Leave Employee elects to continue enrollment in the County’s

group health benefits Employee does not return to work within 12 months of

Military Leave commencement date

Answer Benefits will be terminated after 12 months Employee responsible for paying benefit premiums at active

employee rates for 12 months COBRA coverage available

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Examples

Military Leave Scenario Employee is approved for Military Leave Employee elects not to continue enrollment in

the County’s group health benefits

Answer Benefits will be terminated the last day of the

month in which employee becomes unpaid COBRA coverage available

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Questions?

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