Medical Leave Rights and COBRA
I am out on an approved medical leave of absence for breast cancer treatment. My employer is making me go on Cobra and will not allow me to stay on the company insurance plan. However, his policy manual states “while on leave, your group benefits will continue, as long as you continue to pay your portion of the monthly premium” When I brought this to his attention via email, this is his reply…”You are no longer eligible for coverage because you are no longer working 35 plus hour per week. This is mandatory for all people enrolled in our plan. There are no exceptions. COBRA will cover you during your convalescence. You will pay the health care provider directly”
Is this legal? Can he do this? His response appears contradictory to his policy manual. Do I have any recourse?
You are correct, the policy manual does seem to contradict what you are now being told. The part that appears to be up for interpretation is our group benefits will continue, as long as you continue to pay your portion of the monthly premium. This can be considered true about COBRA, but your portion of the monthly premium under COBRA is 100%. The question is whether or not he is abiding by the Family and Medical Leave Act. The law applies to employers with more than 50 employees, and states Covered employers must grant an eligible employee up to a total of 12 workweeks of unpaid leave during any 12-month period for one or more of the following reasons. One of the stated reasons is to take medical leave when the employee is unable to work because of a serious health condition.
Does your employer have more than 50 employees? And, have you been on medical leave for 12 weeks?
We can’t interpret your company’s benefits policies to determine if you have a legal claim because we are not in a position to provide legal advice. An employer, if not in violation of the Family Medical Leave Act, can require you to go on COBRA if you are no longer working the required hours to qualify for benefits under the group health plan. If you feel that his stance now is contradictory of your understanding of the company policy, you need to contact an employee benefits attorney for a better understanding of your legal rights. You might also try the Consumer Services Division of the California Department of Insurance. This is probably not an issue that they will mediate for you, but you can certainly ask about that. Their toll free phone number is 800-927-4357. One other source worth contacting is your insurance company’s customer service department. They may be able to provide you with some additional guidance.
I have a question that relates to this one as well. One of our fellow workers has recently had heart surgery and is now off the job on FMLA leave because our company unfortunately does not allow sick time. We have found out that the company is working on revoking his health insurance policy, because he apparently hasn’t put in the minimum required hours per month to qualify for his health insurance policy to be extended. As so, they are telling him, he needs to continue his coverage on Cobra, but to my understanding Cobra is only for employees that are fired or resigns. As he has not been fired, nor has he resigned, how can he be covered under Cobra? What are his other options? It is under Michigan law by the way. Can an employer really drop a health insurance polict if their employee has a serious medical condition?
Comment by Ruth — May 30, 2009 @ 10:51 am