Taking leave under the Family and Medical Leave Act (FMLA) is often essential when facing a serious health condition, welcoming a new child, or caring for a loved one. During this critical time, one of the biggest concerns employees have is whether their health insurance will remain in place. Losing access to medical coverage in the middle of a family or medical crisis can be devastating.
While the FMLA provides important protections for your health benefits, there are circumstances where coverage can be interrupted. Understanding these rules is the first step in protecting yourself and your family.
If you are concerned about losing your health insurance while on FMLA, call Tuckner, Sipser, Weinstock & Sipser at 212-766-9100 to discuss your rights and options.
What Does the FMLA Say About Health Insurance?
Under the FMLA, eligible employees are entitled to continue their group health insurance coverage during their leave under the same terms as if they were actively working. This means your employer must maintain your health plan coverage, including family coverage, if that is what you had before your leave began.[1]
Importantly, you remain responsible for your share of health insurance premiums during FMLA leave, just as if you were still working.
What Types of Health Plans Are Covered by FMLA?
The FMLA requires employers to maintain any group health plan that an employee was enrolled in before starting leave. This includes:
- Medical, dental, and vision plans.
- Prescription drug coverage.
- Mental health benefits.
- Family or dependent coverage.
Employers are not required to maintain non-health benefits such as life insurance, disability insurance, or retirement contributions unless they provide the same continuation for employees on other forms of unpaid leave.
Who Pays the Premiums While I Am on FMLA?
Your employer must continue paying its portion of your health insurance premium while you are on FMLA. However, you must still pay your share of the premium.
- If you normally pay through payroll deduction, your employer should explain how you will make payments while not receiving a paycheck.
- If you fail to make timely payments, your employer may be allowed to terminate your coverage after providing proper notice.
Can My Employer Cancel My Health Insurance During FMLA?
In most situations, your employer cannot drop your health coverage simply because you are on FMLA leave. However, there are exceptions. Coverage may be terminated if:
- You voluntarily drop coverage.
- You fail to pay your share of premiums on time.
- Your employer eliminates coverage for all employees (not just those on leave).
If your coverage is terminated for nonpayment, your employer must still reinstate it when you return to work, without waiting periods or pre-existing condition exclusions.
What Happens if I Do Not Return to Work After FMLA?
If you do not return to work at the end of your FMLA leave, your employer may require you to repay the health insurance premiums it paid on your behalf during your leave. There are exceptions if your failure to return is due to circumstances beyond your control, such as a continued serious health condition.
What Happens if My Employer Changes Health Plans During My FMLA Leave?
If your employer changes insurance carriers or updates the group health plan while you are on FMLA leave, you are entitled to the same coverage options as employees who are actively working. You cannot be excluded from new benefits or forced to go through new waiting periods simply because you are on leave.
Does New York Paid Family Leave (PFL) Affect My Health Insurance?
New York’s Paid Family Leave (PFL) law is separate from the federal FMLA, but it also requires continuation of health insurance benefits during leave. Employees must continue paying their share of the premium, just as under FMLA.[2]
How Can I Protect My Health Coverage While on FMLA?
To avoid losing coverage:
- Confirm your employer’s policy for premium payments before your leave begins.
- Make payments on time and in full.
- Keep records of payments and correspondence with HR.
- Contact an attorney immediately if your coverage is threatened or wrongfully terminated.
How Is COBRA Different From FMLA?
Employees often confuse FMLA continuation of coverage with COBRA continuation coverage. The two laws work differently:
- FMLA requires your employer to maintain your group health plan during your protected leave, as if you were still employed.
- COBRA gives you the option to continue health coverage at your own expense after employment ends or if your coverage is otherwise terminated.
If you do not return to work after FMLA and your coverage ends, COBRA may allow you to keep your health insurance, but you will likely pay the full premium plus administrative costs.
What Rights Do Part-Time or Reduced-Schedule Employees Have?
The FMLA not only covers full-time employees on continuous leave, but also those who take leave on an intermittent or reduced-schedule basis. Your employer must maintain your health insurance during intermittent leave on the same terms as if you were working full-time.
What Should I Do if My Employer Wrongfully Terminates My Health Insurance?
If your health insurance is terminated while you are on protected FMLA leave without a lawful reason, you may have claims under both the FMLA and federal or state anti-discrimination laws. Steps to take include:
- Documenting communications with HR or your supervisor.
- Keeping copies of premium notices or cancellation letters.
- Contacting the U.S. Department of Labor or the New York State Department of Labor.
- Speaking with an FMLA lawyer immediately to preserve your rights.
Why Legal Guidance Matters
Understanding the fine print of your health insurance rights under the FMLA can be confusing. Employers do not always explain the rules clearly, and mistakes can cost you coverage at the moment you need it most.
At Tuckner, Sipser, Weinstock & Sipser, we help employees protect their rights under federal and state leave laws. We can:
- Review your employer’s health insurance obligations.
- Challenge wrongful terminations of coverage.
- Ensure your reinstatement rights are enforced when you return to work.
Call us today at 212-766-9100 for a free and confidential consultation.
With more than 35 years as a New York FMLA lawyer, Jack Tuckner has represented countless women and families who are eligible for FMLA. At Tuckner, Sipser, Weinstock & Sipser, a New York FMLA law firm, we have the experience to guide you through FMLA rights and obligations and ensure you are in compliance with the law.