Medical Coverage Employer/Employee Question

[kellymom]

Ladies-

I don't know that any of you will know the answer to this, but I thought this would be a great place to ask!

My SIL is an hourly employee at a surgical center in Virginia (less than 50 salaried employees) and has to have major surgery this summer which will require her to take at least two weeks off of work. She was informed today that she will be responsible for paying the total amount of her insurance premium during that time (over $700) because she will not be working and they don't offer medical leave. Normally she has $125 taken out of each check for her part. She is wondering if this is legal on the off chance this does not have to happen. Does anyone know?

Thanks, ladies!

Kelly

 

[DebbieH]

My husband said for her to go to her employee handbook and it will spell out the rules pertaining to her situation...good luck!

 

[Sunshine1528]

HR Mgr here . . . I'm guessing the "medical leave" you are referring to is FMLA which is federal Family Medical Leave Act which protects your job and benefits if the employer has over 50 employees in a 75 mile radius.

If there are less than 50 employees then it is possible she may be termed from the medical plan for not working enough hours and/or be responsible for paying the premiums. If she is not termed from the company, she would typically be reinstated upon returning to the standard # of hours required to remain on the plan. If for some reason she is termed, then COBRA paperwork should be sent to her. In that case, she would be required to pay the entire amount + up to 2% administrative fees. (That usually does not happen for durations less than 30 days).

Here's is what typically happens with a fully insured medical plan though - you must be terminated (which usually happens the first day of a calendar month) or work less than the required # of hours for continued coverage - but that is usually 30 days, and then you would be termed the first of the following month.

If she is only going to be off for 2 weeks, I doubt there would be any lapse in coverage or difference in the premiums required to be paid by the employer. Will she be receiving a check for paid time off (either vacation or sick)? If so, can they not just deduct the typical premiums from that check?

ITA with DebbieH and check the handbook and/or the medical Summary Plan Description (describes how the benefit is administered and claims are paid). If they state what she has told you, seems strange to me.