Welcome to Unum's. Leave Management Human Resources Training

Transcription

1 Welcome to Unum's Leave Management Human Resources Training

2 FMLA/State Leave Management Process FMLA Intermittent Management FMLA/State Leave Management Reporting Responsibility and Communication

3 Experienced Leave Management Quality services to help ease administrative and regulatory burden Here s what you can expect: Over 15 years of leave management experience, now servicing over 640 employers from multiple industries Compliance with Family and Medical Leave Act and over 225 state leave laws Administration of employer-specific leaves of absence Dedicated legal resources Continual scanning of all legislative activity related to changing leave regulations Additional benefits: Clinical support Benefit coordination and integration Quality and timely decisions Employee and employer communications Unum takes over the administrative burden

4 FMLA/State Leave Management Process

5 FMLA Refresher FMLA gives your employees 12 weeks of leave. They may miss work due to: Their own serious health condition A family member s serious health condition The birth, adoption, or foster care placement of a child A qualifying exigency leave for a family member in the military A military caregiver leave for a servicemember **26 weeks of leave available for military caregiver To be eligible for FMLA leave, an employee must: Have 12 months of service Have worked 1,250 hours in the last 12 months Work at a location with 50 or more employees within 75 miles

6 Leave/Claim Intake Process When an employee calls Unum, and selects the option to initiate a new leave, our contact center walks the employee through a detailed Q&A in order to: Validate the employee s identity Establish an ongoing relationship with the employee Gather information to set up our expert resources for success in decision-making Answer any questions the employee may have Give the employee any information regarding the next steps Cultivate a return to work mindset

7 After New Leave Is Requested Within 2 business days of the leave request, Unum will mail a packet to the employee containing: Notice of eligibility or ineligibility for FMLA and/or State leave FMLA Rights & Responsibilities If eligible: Conditions of leave and employee obligations Medical Certification form (if applicable) Permission to Contact form (if applicable) If the employee is not eligible and/or not qualifying for leave, the assigned leave specialist will attempt to contact the employee by phone to advise ineligibility.

8 Medical Certification Requirements FMLA/State leave with a concurrent STD claim No medical certification form is requested for the FMLA leave FMLA will be approved concurrently with the STD claim If the STD claim is not approved or if STD does not make a decision, Unum will review any medical information already submitted (as allowed by State law), then send a subsequent request for medical certification if needed If certification is requested, employees have 18 days to submit documentation FMLA/State leave only (no concurrent STD claim) If eligible, a medical certification form or appropriate documentation is requested Note: Certifications are reviewed by leave specialists.

9 FMLA Certification Timeline For Non-Integrated Leaves Day 1 - Report of family medical leave Certification is due 15 days from the date of request Day 16 - Certification Reminder letter sent to employee if certification has not been submitted Certification due date extended 7 calendar days Day 23 - FMLA/State leave denial letter sent to employee if certification not submitted Incomplete certifications received are returned to employees with a certification due date extension Certification due date is extended 7 calendar days from original due date or 10 calendar days from the date of the incomplete letter, whichever is later

10 Certification Review and Leave Consultation Clarification Needed for Insufficient Certifications Unum will contact the doctor (with signed Permission to Contact form) Complete Certification Must support the leave request and a serious health condition under FMLA regulations/state leave law Validity Questioned Verify authenticity Request recertification Request 2nd/3rd opinion on original certifications

11 Certification Grace Period The Certification Grace Period is a federal regulation, that will apply complete and qualifying certification and/or the integrated disability approval decision received following the denial of a leave. Only the initial 15 day period from the date of the request for certification/documentation will be covered under FMLA. If the employee is not directly notified of the need for certification, 3 days will allowed for mail time and consider the 4th day from the date the letter is mailed as the date of written notification. Unum will only apply the 15 day certification grace period to information received within one year from the date of denial.

12 Return to Work Unum calls the employee to verify return to work plans Reminds employee to submit return to work authorization, if applicable s the employer if the estimated return to work date has changed Confirms actual return to work date with employer via

13 Communication Between Unum and your Employees Letters Eligibility status, approval/denial updates, etc. Registered employees are notified of leave changes and requests Can access web services Review letters/correspondence Can submit information: updated leave dates, contact info, etc. Can report intermittent absences

14 FMLA Intermittent Management

15 Certifying Intermittent Leave In order to manage intermittent leaves effectively, Unum carefully screens medical certifications submitted to determine the health care provider s expectations. Unum requires: The health care provider to certify that intermittent leave is necessary The probable frequency of episodes, if known The estimated treatment schedule, if known

16 Monitoring Absence Frequency and Duration Monitoring treatments and episode frequency If an employee s absences differ by more than 2 absences from the certified frequency Our expert medical staff will review the leave to determine if the absences are appropriate A significant change in circumstances will initiate a recertification Unknown frequency and duration Physicians are clearly directed to provide specific frequency information Unknown may be acceptable Unum will then allow unknown frequencies but will review if the employee has more than 3 full or partial absences in a calendar month.

17 Ongoing Intermittent Leave Absence reporting Each absence reason is evaluated to ensure: It is consistent with the leave reason The frequency is supported There is no pattern of absence The notice requirement is met Entitlement deduction Absences are entered to-the-minute to ensure: Entitlement is accurate FMLA time replenishes correctly Recertification For ongoing conditions, we can request certification every 6 months to ensure: The employee still needs intermittent leave The estimated frequency/duration is still current

18 Reporting Intermittent Time The employee can report time to Unum three different ways: Web Services Mobile App Telephonic When reporting intermittent time we will request the following information: Reason for the absence Start/end time of absence Duration of lunch (if within absence timeframe) If for treatment, physician name and appointment time

19 19 Benefits - FMLA Intermittent Absence Tool

20 Responsibilities and Communications

21 Employee Responsibilities Contact Unum immediately to report Family/Medical leaves or Disability claims Notify manager/supervisor of leave request Supply requested documentation to Unum within specified timeframes Provide Unum with signed copy of relevant authorization to release information Notify Unum and manager/supervisor of any changes in return to work status or date

22 Manager Responsibilities Be sure that your employee reports all family/medical leaves to Unum promptly For the purpose of PTO Track and monitor any time taken based on your company s sick leave policy Tell Unum if you have any problems or concerns regarding a leave If for any reason an employee has not reported a leave to Unum, then HR or the employee s manager/supervisor should do so as soon as possible in order to facilitate compliance Notify payroll of any unpaid time off work in a timely manner Work with local HR if disciplinary or employment action is required

23 Human Resources/ Division Contact Responsibilities Provide employee with leave brochure as requested Be sure all family/medical leaves are reported to Unum promptly Facilitate an ongoing dialogue with Unum regarding status determinations, problem/suspec t leaves and other extenuating circumstances Facilitate appropriate disciplinary or employment action based on the absence information on Daily and Weekly reports If for any reason the employee has not reported a leave to Unum, then HR or the employee s manager/supervisor should do so in order to facilitate compliance.

24 Notification/ Information Request Employer identified contact receives an at the following points: New Leave Request Projected Return to Work Update Leave Status and/or Date Changes Intermittent Hours Reported Exhaustion Notification Eligibility Information Needed Return to Work Confirmation Needed

25 Sample of New FMLA Leave Status Notification Top fields: identifying information and leave dates Body: Detailed status of FMLA/state leave and disability (if applicable) Status: pending, approved, denied Status reason: waiting certification, short term disability decision, etc. Multiple time frames may be represented Contact information

26 When s request information from you: You may receive s requesting additional information or clarification. These are the most common: Request eligibility Missing/conflicting information Temporary or pre-acquisition time Break in employment or served in the military Significant leave history Last day worked / Leave start date Reason for gap in last day worked and leave start date Confirm return to work Full-time/part-time Gap in approved-through and return to work dates

27 Unum s Responsibilities Ongoing contact with employees Ongoing updates to employers Assigned leave specialists are available regarding the administration of a specific leave Managers and Lead Leave Specialists are available for consultative support for leave escalations and complex scenarios.

28 Thank You