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Continuation of Benefits--Leave without Pay (LWOP)

HROG Section:
Work/Life
Document Title:
Continuation of Benefits
Initial Date Posted:
Board Approval:
Applies To:
All full-time DCCCD employees
Source:
District Human Resources
Related TASB Policy:
Last Date Revised:

Purpose

Background

Definitions

Eligibility

Procedures

Continuation of Benefits/Leave Without Pay 
An employee is offered continuation of benefits when they enter a leave without pay status with the exception of Family Medical Leave.

When an employee is on leave without pay for a full month and is participating in the Family Medical Leave Act (FMLA), the employee only insurance is continued for a maximum of 12 weeks.  This leave may run concurrently with disability and workers compensation insurance benefits.

In order to offer continuation of benefits, the employee must be inactive but not terminated and not receiving any paid DCCCD leave for an entire month.  The employee is not eligible for the State contribution for employee only insurance.

The employee is eligible to continue all insurance coverage while in a leave without pay status by making the premium payment.  These premiums payments are made directly to the Employees Retirement System (ERS).

The employee can choose the coverages that they want to continue.  The coverages they do not continue will be cancelled.   Disability premiums are waived when an employee is in a full month’s leave without pay, regardless of whether they are receiving disability benefits.

The employee can participate in continuation of benefits for a maximum continuous period of 12 months.
 
If the employee is participating in the TEXFLEX reimbursement account for health care (HCRA), the employee must continue to make their monthly contributions until the plan year ends.  They may process claims through their reimbursement account while they are in a leave without pay status.   If they participate in the dependent care account (DCRA), they are not eligible to continue their monthly DCRA contributions.  Questions regarding TEXFLEX accounts should be directed to ERS by calling 1-800-252-3645.   

Holding the Position
The department supervisor that is responsible for the management of the department may not want to hold the employee’s position while the employee is in a leave without pay status.  Employees that are in contractual positions must be held until the contract expires.  The District is under no obligation to hold a non-contractual position when a leave without pay status occurs.  The department should make a decision concerning the likelihood of the employee returning to work.   The American Disability Act must also be a part of the action when making the decision to hold the position.   If the department can not sufficiently support the job duties of the leave without pay employee, a decision may be made to terminate the employee.  The employee would not be offered continuation of benefits, but COBRA instead.

If the likelihood is that the non-contractual employee will return in a sufficient amount of time, the department may hold position.  

Notification of Leave Without Pay
When an employee enters a full-month of leave without pay and/or on FMLA, the location Human Resources office must notify the District Service Center payroll office immediately.  This notification should be made to payroll for their office to reconcile insurance benefits.  The location Human Resources office should also change the status of the employee in the ERS Peoplesoft system.   

The employee must be notified in writing of the following:

  • The FMLA period has expired – give date of expiration
  • Insurance coverages they are presently participating
  • Cost of those coverages
  • The length of time they can pay out of pocket premiums to continue the coverage
  • Where to mail the check or money order for insurance coverages
  • When to make payment to continue insurance coverages
  • Who to make the check or money to (includes TEXFLEX HCRA)
  • How to cancel or waive coverages
  • Cancellation policy due to non-payment
  • If the employee waives coverages, a COBRA notification may be generated and an offer of COBRA should be made to the employee and applicable dependents
  • The return to work policy for reinstatement of insurance coverages

An employee in a leave without pay status cannot add coverage or dependents through evidence of insurability or make TEXFLEX changes without an eligible change in family status, or add Voluntary AD&D coverage.

Reinstatement of Coverage when Returning To Work
The policies for employees returning to work may vary depending on whether coverages were maintained, reduced or cancelled during the leave without pay status.

Continued Coverage, the following applies:

  • Notify District Service Center payroll to complete a Status Change Certification and/or
  • If enrolled in TEXFLEX, report status change to TEXFLEX through reconciliation.
  • If new plan year, verify IEBS monthly salary.
  • If enrolled in disability coverage, reinstate disability coverage by completing the multi-purpose form effective the day they return and inputting into IEBS.  You do not need the employee’s signature to reinstate coverage.  Check the rates to make sure the employee is being charged the correct premium.
  • If the employee is not returning to work in the same plan year, the employee may be eligible to re-elect TEXFLEX.

Cancelled or reduced coverage in the same plan year, the following applies:

  • The employee has 30-day eligibility period from the date of return to work.
  • Must reinstate employee only basic health coverage or automatic enrollment, employee must re-enroll in Health coverage – if Health Select, employee may enroll only through the EOI process, including dependents, coverage is not guaranteed.
  • HMO coverage cannot be reinstated unless the employee and/or dependents have been officially denied coverage by Health Select.
  • EOI is required to reinstate short and long term disability, if approved a new pre-existing conditions exclusion begins.
  • EOI is required to reinstate Optional Term Life and Dependent Term Life.
  • Voluntary AD&D may be reinstated without EOI.
  • Reinstate TEXFLEX reimbursement account for DCRA and reinstate premium deduction for HCRA.

Cancelled or reduced coverage not in the same plan year, the following applies

  • Treat like a new employee using the same eligibility standards.  They have the 30-day eligibility period to enroll in coverages.

Employees on leave without pay September 1 (during Annual enrollment), the following applies if returning to work in a 30-day period after September 1

  • A change to health coverage that does not require an EOI – they may enroll in an HMO.
  • May add dependents to an HMO,
  • Can make changes to dental carrier
  • Drop or decrease coverages
  • If applying for coverage through EOI, the employee must return to work no later than 30 days after the location receives the approval.
  • Add or decreases to AD&D will not be effective until the employee returns to work.
  • The employee may make TEXFLEX elections upon return to work.

ERS Automatic Drop Notification
When an employee has exhausted the 12 months of leave without pay, ERS will automatically generate a report to let the Benefits Coordinator know that all coverages have been dropped. 

In order for an employee to continue coverage, the employee must be offered COBRA under the appropriate qualifying event.  All COBRA qualifiers do not necessarily mean termination of employment from the DCCCD.  In some instances, the employee will remain an employee of the District in an inactive status.  

Employee Responsibility

HR Responsibility

Exceptions To Policy

Employees who do not work in the summer are not considered in a leave without pay status.  The types of employees, usually full-time faculty or an employee who has been hired to work less than 12 months, have pre-paid for their insurance optional coverages to be extended into the summer.  

Other Notes

Employees on Leave Without Pay the day before and/or the day following the holiday shall not receive compensation for the holiday during such leave. 

An employee who is absent without proper authorization on the day before and/or the day following a holiday shall not receive compensation for such holiday.

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