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The basics of maternity leave
If you’re thinking about starting a family, it’s a good idea to plan for the unexpected – especially when it comes to your health insurance. You should plan for changes in your medical condition, job status and health insurance benefits. What if your doctor advises you to take some time off from work when you become pregnant? Or orders you to stay in bed for half of your pregnancy?
It’s important to know the details of your employer's policy regarding pregnancy leave and other pregnancy-related benefits.
Employers are not required by federal law to provide pregnancy-related disability leave to their employees.
Figuring out which benefits are applicable to your situation and how they coordinate with each other can be tricky. After all, an employer doesn't have to offer medical insurance to its workers and if it does, it can elect to forgo or limit maternity coverage. This is also the case with short-term and long-term disability insurance. Employers are not required by federal law to provide pregnancy-related disability leave to their employees – though many do.
First, carefully read the your health plan’s Explanation of Benefits (EOB). If you have questions after reading the manual, write them down. Take the list to your human resources director or health insurance plan administrator, who should be able to help you find the answers.
Second, become familiar with the concepts behind pregnancy-related benefits. For example, pregnancy-related disability leave covers the period of time during which a woman is incapacitated by pregnancy, childbirth or a related condition, and is away from the workplace. It’s different from parental leave. Parental leave is usually a nonmedical leave taken voluntarily by men or women to care for a newborn or newly adopted child.
Benefits and the Pregnancy Discrimination Act
The federal law that governs maternity leave is the Pregnancy Discrimination Act (PDA). According to the act, pregnant women must be treated in the same manner as other applicants or employees with similar abilities or limitations.
When determining eligibility for pregnancy and maternity leave and administering pregnancy-related health insurance benefits, there are certain rules employers and health plan administrators must follow:
• Your employer may not single out pregnancy-related conditions to determine your ability to work. However, it may screen you by using procedures it requires of other employees. For example, if your employer requires all of its employees to submit a doctor's statement concerning their inability to work before granting leave, the employer may require you to do so as well.
• If you're temporarily unable to perform your job due to pregnancy, your employer must treat you the same as any other temporarily disabled employee. For example, by providing you with modified tasks or alternative assignments or by granting you disability leave or leave without pay.
• Your employer must hold open your job for the same length of time jobs are normally held open for employees on sick or disability leave.
• If your employer offers health insurance that covers maternity benefits, your health insurance must cover expenses for pregnancy-related conditions on the same basis as costs for other medical conditions.
• If you have health insurance that covers pregnancy-related health care expenses, they should be reimbursed exactly as those incurred for other medical conditions.
• The amounts payable by your insurer can be limited only to the same extent as costs for other conditions. No additional, increased or larger deductibles can be imposed for pregnancy.
• Pregnancy-related benefits cannot be limited to married employees.
• If your employer provides benefits to workers on leave, it must extend the same benefits to those on leave for pregnancy-related conditions.
• If you are pregnant, your employer must treat you the same as any other temporarily disabled employee for accrual and crediting of seniority, vacation calculation, pay increase and temporary disability benefits.
How maternity leave coordinates with the Family Medical Leave Act
After you have determined your eligibility for pregnancy-related benefits, you also need to be aware of how they may coordinate with the Family Medical Leave Act (FMLA). This federal law entitles eligible employees to take 12 weeks of unpaid leave for certain family and medical reasons (such as the birth of a child) during any 12-month period, according to the U.S. Department of Labor.
The paid leave and the FMLA leave run concurrently, and the time taken off is counted against both.
The FMLA gets tricky in certain situations in which an employer is allowed to require an employee seeking FMLA leave to use accrued paid leave (such as vacation time, personal time, pregnancy-related disability leave or sick leave) as a substitute for unpaid FMLA leave. In these instances, your paid leave and your FMLA leave run concurrently, and the time taken off is counted against both. That’s why it's important for you to understand your employer's benefit offerings and whether your company requires its workers to use paid leave as a substitute for unpaid FMLA leave.
Employers have their own FMLA responsibilities. According to federal law, an employer wishing to count paid leave against the 12-week unpaid FMLA leave must inform the employee within two days of learning of the employee's FMLA leave request. If the employer fails to meet this deadline, it may not retroactively designate the leave as counting toward FMLA leave. Only the portion of the leave following the notification by the employer may be designated as FMLA leave and counted against the 12-week entitlement.
For example, if your employer knows on Monday morning that your paid leave starting that day is for FMLA reasons, it must make its FMLA designation by Wednesday morning. If your employer waits until the following Monday, the leave taken the prior week does not count as FMLA and you begin your second week of leave with a full 12 weeks of FMLA eligibility remaining.
In order to qualify for FMLA benefits, an employee must have worked for the employer for the previous 12 months and logged at least 1,250 hours.
What does this mean if you're pregnant and you qualify for both pregnancy-related disability benefits and FMLA leave? Your employer can require your pregnancy-related disability benefits to run at the same time as your FMLA leave. For example, let’s say you have a total of 12 weeks of paid vacation and disability leave. If you take it, you have used up both your paid disability leave and unpaid FMLA benefits. You do not get an extra 12 weeks of unpaid leave.
Key provisions of the FMLA
Not everyone is eligible to receive benefits under the FMLA, according to the U.S. Department of Labor, and there are several key regulations. Among them are:
• FMLA applies to all public agencies, including state, local, and federal employers, and to schools.
• FMLA applies to private-sector employers that employed 50 or more employees in 20 or more work weeks in the current or preceding calendar year.
• In order to qualify for FMLA benefits, you must:
• Work for a covered employer.
• Have worked for your covered employer for a minimum of 12 months.
• Have worked at least 1,250 hours over the previous 12 months.
• If you are FMLA eligible, your employer must grant you a total of 12 weeks of unpaid leave during any 12-month period for one or more of the following reasons:
• For the birth and care of your newborn child.
• For your adoption or foster care placement of a child.
• To care for your spouse, child or parent with a serious health condition.
• To take medical leave when you're unable to work due to a serious health condition, including pregnancy-related health conditions.
Keeping your benefits under FMLA
FMLA requires your employer to maintain your health insurance and job benefits during your FMLA leave.
One of the most important aspects of FMLA is that it requires your employer to maintain your health insurance and job benefits during your FMLA leave. Under federal law, your employer must continue your health insurance on the same terms as if you had continued to work. If applicable, your employer will make arrangements for you to pay your share of health insurance premiums while you are out on leave.
But take note. Your employer also has the legal right to seek to recover any health insurance premiums it paid to maintain your health insurance coverage if you fail to return to work from your FMLA leave.
FMLA also requires your employer to restore you to your original job when you return from your FMLA leave, or to an equivalent job with equivalent pay and benefits. Additionally, your use of FMLA benefits cannot result in the loss of any benefit that you earned or were entitled to before using your FMLA leave.
If you believe your employer has violated any provisions of the FMLA, you can file a complaint with the Department of Labor (DOL), the agency that oversees this federal law. For more information and the appropriate forms, visit the DOL Web site.