The Guide to USPS Health Benefits (USPS HB) Plan for noncareer employees has a section that violates the Family and Medical Leave Act (FMLA) regulations for employees with FMLA protection. On pages 23-24, regarding “Possible Loss of Coverage because of Insufficient Pay and Failure to Pay Premiums,” it denies an employee some important rights and benefits they are entitled to under the FMLA. To be eligible for FMLA protection, an employee must have worked for the USPS for at least one year and have worked at least 1,250 hours during the 12 months prior to the start of the FMLA leave.
If you have the USPS HB Self Plus One or Self and Family plan and you fail to earn sufficient pay for withholding of your USPS HB premiums for two pay periods due to a FMLA reason, you could lose ALL of your USPS health insurance coverage, including for yourself, retroactively. To stop the USPS from terminating your health insurance retroactively, you must make a payment to the Eagan ASC within 30 days of their invoice. Termination of your USPS HB plan for nonpayment does not apply if you have the Self Only option. It also does not apply if you are enrolled in any Federal Employees Health Benefits (FEHB) plan like the APWU Consumer Driven Health Plan.
In addition to retroactive termination of your USPS HB plan, you will be required to reimburse the USPS HB plan and the provider for any benefits that were provided to you and your dependents because they terminated your insurance retroactively. They will further punish you by not allowing you to reenroll in a health plan until the next health benefits Open Season or Qualified Life Event. These penalties conflict with the Family and Medical Leave Act regulations, which say the following:
(e) An employer may not require more of an employee using unpaid FMLA leave than the employer requires of other employees on leave without pay.
(a) (1) In order to drop the coverage for an employee whose premium payment is late, the employer must provide written notice to the employee that the payment has not been received. Such notice must be mailed to the employee at least 15 days before coverage is to cease, advising that coverage will be dropped on a specified date at least 15 days after the date of the letter unless the payment has been received by that date. If the employer has established policies regarding other forms of unpaid leave that provide for the employer to cease coverage retroactively to the date the unpaid premium payment was due, the employer may drop the employee from coverage retroactively in accordance with that policy, provided the 15-day notice was given. In the absence of such a policy, coverage for the employee may be terminated at the end of the 30-day grace period, where the required 15-day notice has been provided.
(b) The employer may recover the employee’s share of any premium payments missed by the employee for any FMLA leave period during which the employer maintains health coverage by paying the employee’s share after the premium payment is missed.
(c) If coverage lapses because an employee has not made required premium payments, upon the employee’s return from FMLA leave the employer must still restore the employee to coverage/benefits equivalent to those the employee would have had if leave had not been taken and the premium payment(s) had not been missed, including family or dependent coverage. See § 825.215(d)(1)-(5). In such case, an employee may not be required to meet any qualification requirements imposed by the plan, including any new preexisting condition waiting period, to wait for an open season, or to pass a medical examination to obtain reinstatement of coverage. If an employer terminates an employee’s insurance in accordance with this section and fails to restore the employee’s health insurance as required by this section upon the employee’s return, the employer may be liable for benefits lost by reason of the violation, for other actual monetary losses sustained as a direct result of the violation, and for appropriate equitable relief tailored to the harm suffered.
In The Employer’s Guide to the Family and Medical Leave Act, between pages 59 to 65, the DOL spells out in plain English the employer’s obligation to maintain health benefits when employees go on FMLA leave or return from FMLA leave.
PSEs who pass their one-year service anniversary should immediately switch to the APWU Consumer Driven Health Plan. It is a far more generous health plan and has lower premiums. Another perk is that your FEHB premiums are automatically tax-free. After conversion to career, your APWU health plan premiums will drop even lower.
First Name: Don
Last Name: Cheney
Union/Local: APWU – Auburn WA Local
Office held if any: Retired President