In accordance with the Family and Medical Leave Act of 1993, and its regulations updated effective January 16, 2009, (the Act), eligible employees may take a leave of absence because (1) of the birth of a son or daughter and in order to care for such son or daughter; (2) of the placement of a son or daughter with the employee for adoption or foster care; (3) the employee is unable to work due to his/her own serious health condition; (4) the employee needs to care for a spouse, son or daughter or parent with a serious health condition; (5) of a qualifying exigency arising out of the fact that a spouse, son or daughter or parent is on active duty or call to active duty status in support of a contingency operation as a member of the National Guard or Reserves; or (6) you are the spouse, son or daughter, parent or next of kin of a covered servicemember with a serious injury or illness. To be eligible for FMLA leave, you must: 1. Have been employed by the Company for at least 12 months, which need not be consecutive. The regulations allow for a break in service of no more than seven (7) years. The employee should submit proof of eligibility based on prior service when requesting leave and the break in service is 3 years or more in length. The Military Leave Act provides an exception to the 7-year rule where breaks in service are resulting from an employee s fulfillment of National Guard or Reserve military service. 2. Have worked at least 1250 hours for the Company during the 12 month period immediately preceding the commencement of the leave. 3. In addition, there must be at least 50 employees at your location or within a 75-mile radius of the Company. An employee s total cumulative FMLA leave under this policy may not exceed 12 weeks in any 12-month period, and all unused paid leave benefit(s) must be used as part of the 12 weeks available. - An employee has the right under the FMLA for up to 12 weeks of unpaid leave in a 12-month period calculated as a rolling 12-month period measured backward from the date of any FMLA leave usage. - A husband and wife who are eligible for FMLA leave, and are employed by the Company, are limited to a combined total of 12 weeks of leave during any 12-month period if the leave is to care for the employee s parent with a serious health condition, for the birth of the employee s son or daughter, or to care for the child after the birth, or for placement of a son or daughter with the employee for adoption or foster care, or to care for the child after placement. FMLA leave for the birth or placement of a child must be completed within one year after the birth or placement of that child. Family Military Leave Entitlements - Eligible employees with a spouse, son, daughter, or parent on active duty or call to active duty status in the National Guard or Reserves in support of a contingency operation may use their 12-week leave entitlement to address certain qualifying exigencies. Qualifying exigencies may include attending certain military events, arranging for alternative childcare, addressing certain financial and legal arrangements, attending certain counseling sessions, and attending post-deployment reintegration briefings. We may require employees to provide a copy of the covered military member s active duty orders or other military issued documentation that indicates that the covered military member is on active duty in support of a contingency operation, and the dates of the active duty service. - FMLA also includes a special leave entitlement that permits eligible employees to take up to 26 weeks of leave to care for a covered servicemember during a single 12-month period. A covered servicemember is a current member of the Armed Forces, including a member of the National Guard or Reserves, who has a serious injury or illness incurred in the line of duty on active duty that may render the servicemember medically unfit to perform his or her duties for which the servicemember is undergoing medical treatment, recuperation, or therapy; or is in outpatient status; or is on the temporary disability retired list. General Provisions Notice of Leave Employees must provide at least 30 days advance notice of the need to take FMLA leave, when the need is foreseeable, to the appropriate Company representative. When 30 days notice is not possible, the employee must provide notice as soon as practicable and must comply with the Company s normal call-in procedures required for other absences. If less than thirty (30) days notice is given, the employee must explain why providing timely notice was not practicable. FMLA Statement of Policy 2018 Rev 0112 Page 1 of 6
When requesting leave for the first time for a particular FMLA-qualifying reason, the employee must provide sufficient information for the Company to determine if the leave may qualify for FMLA protection and the anticipated timing and duration of the leave. Sufficient information may include that the employee is unable to perform job functions, the family member is unable to perform daily activities, the need for hospitalization, or continuing treatment by a health care provider. Calling in sick is not enough. Employees must also inform the appropriate Company representative if the requested leave is for a reason for which FMLA leave was previously taken or certified. Employees also may be required to provide a certification and periodic recertification supporting the need for leave. The Company must inform employees requesting leave whether they are eligible under the FMLA. If they are, the notice must specify any additional information required as well as the employee s rights and responsibilities with regard to FMLA leave. If an employee is not eligible, the Company must provide a reason for the ineligibility. The Company will generally notify an employee within five (5) business days whether he/she is eligible for FMLA leave. Intermittent or Reduced Scheduled Leave An intermittent or reduced leave schedule may be taken for the serious health condition of the employee or employee s family member. The employer and employee must agree first before either of these leave schedules may be used for the birth or placement of a child. Both active duty leave and servicemember family leave can be taken on an intermittent or reduced schedule leave basis when medically necessary. When the intermittent leave or reduced schedule is foreseeable, the employee must try to schedule the leave so as to not unduly disrupt Company operations, and may be temporarily transferred to an alternative position for which he/she is qualified with equal pay and benefits and which better accommodates the intermittent or reduced schedule leave. Intermittent leave is accounted for using an increment of one hour. For part-time employees and those who work variable hours, FMLA leave entitlement is calculated on a proportional basis. Example: An employee normally works 30 hours per week and reduces their hours to 20 per week on a reduced schedule leave. The 10 hours of FMLA leave equals one-third of a week of FMLA leave each week. Unable/Decline to Return An employee who is unable, or declines to return upon expiration of FMLA leave, will be considered to have voluntarily terminated his/her employment, unless the inability to return is due to a disability covered under the Americans With Disability Act and the employee requests and can reasonably be granted some additional accommodation. Only the President of the Company in extraordinary circumstances may approve exceptions. Medical Certification An employee on medical leave for one week or more due to a serious health condition of the employee or a family member must provide a written medical certification on a form adopted by the Company. The Company may waive this requirement in cases of pregnancy or other situations where the reason for and the timing of the leave are obvious. The certification must be provided 30 days prior to the commencement of the leave when the need for the leave is foreseeable. In all cases, it must be provided within 15 calendar days after the Company requests it. The employee must provide a complete and sufficient certification if required by the employer. A certification is considered incomplete if one or more applicable entries have not been completed or if the information provided is vague, ambiguous, or non-responsive. If certification is found to be incomplete we will inform the employee in writing and give the employee 7 calendar days to cure any such deficiencies. Recertification Employers may generally request a recertification no more often than every 30 days and only in conjunction with an FMLA absence unless a minimum duration of incapacity has been specified in the certification, in which case recertification generally may not be require until the duration specified has passed. In all cases an employer may request recertification of an ongoing condition every 6 months in conjunction with an absence. Medical recertification must be provided within 15 days after Company request during the leave. Except when there is more than 30 days left on the minimum period of incapacity on the original certification, recertification may be requested every 30 days. In addition, recertification may be requested when (1) there is a significant change in condition; (2) an extension of the leave is requested; (3) the Company receives information, which casts doubt on the continuing validity of the prior certification. Upon return to work, the employee will be required to provide a release to return to work certifying his/her ability to return to work on a form approved by the Company. FMLA Statement of Policy 2018 Rev 0112 Page 2 of 6
Failure to Provide Required Certification/Recertification Documents If the employee is notified of a deficiency and fails to cure such deficiencies in the resubmitted certification, the employer may deny FMLA leave. When the leave is due to the employee s own serious health condition, the employee must provide a copy of his/her current job description to the health care provider before obtaining the certification. A copy of the job description may be obtained from Human Resources. In accordance with the Act, the Company has the right to require a second opinion at Company expense. If the opinions of the first and second health care providers differ, the employer may require a third option, at employer s expense, from a health care provider mutually agreed upon by the employer and employee. The third opinion is final and binding. Employers have five business days, absent extenuating circumstances, to provide a copy of a second or third opinion to an employee who requests one. Failure to provide required notices or certifications may result in delay in the leave of absence, or loss of the protections provided by the Act. Qualifying Exigency Certification Employers may require employees to provide a copy of the covered military member s active duty orders or other militaryissued documentation that indicates that the covered military member is on active duty (or has been notified of an impending call or order to active duty) in support of a contingency operation, and the dates of the active duty service. This information need only be provided once; new active duty orders or other documentation must be provided only if the need for leave arises out of a different active duty or call to active duty order of the same or a different covered military member. Employers may contact the individual or entity with which the employee is meeting in order to verify a meeting or appointment schedule and the nature of the meeting. Employers may also contact an appropriate unit of the Department of Defense to request verification of active duty or call to active duty status. In both cases, the employee s permission is not required, and no additional information may be requested. Military Caregiver Leave Certification Employers may require employees to obtain a certification completed by an authorized health care provider of the covered service member on a form as provided by the employer. In lieu of the DOL form WH-385, or the employer s own certification form, an employer must accept invitational travel order (ITOs) and invitational travel authorizations (ITAs) issued by any family member to join an injured or ill service member at his/her bedside. The employee does not need to be named in the ITO or ITA, and it is sufficient even if a health care provider does not sign it. Salary/Wages FMLA leave is unpaid, except as follows: An employee must use any type of paid leave concurrently with FMLA leave and must follow the same terms and conditions of the employer s policy that apply to other employees for the use of such leave. The employee is always entitled to unpaid FMLA leave if he or she does not meet the employer s conditions for taking paid leave and the employer may waive any procedural requirements for the taking of any type of paid leave. If the absence is due to a job related injury, the employee may be covered by Worker s Compensation. State Specific Military FMLA For those employees whose domicile residence, or work assignment, is subject to any state specific FMLA or other leave requirements, we will comply with BOTH State and Federal Laws. Where applicable, State FMLA will run concurrently with Federal FMLA. Benefits The Company will maintain your benefits during any period of FMLA leave under the same conditions as if you continued to work. If you do not return to work following FMLA leave you may be required to reimburse your employer for our share of health insurance premiums paid on your behalf during your FMLA leave. The use of FMLA will not result in the loss of any employment benefit that accrued prior to the start of your approved leave. The employee s group benefits that they are participating in prior to leave, or elections made during leave, will remain in effect throughout the FMLA leave period on the same basis as if the employee were not on leave, provided the employee makes timely payment of the employee s share of the premiums. During any paid portion of the leave, the employee s premiums will continue to be deducted from payroll. During any unpaid portion of the leave the employee s share of premium(s) must be agreed to and payment received at the Benefits and Insurance Department. Should you lose benefit eligibility prior to the start of any eligible FMLA leave you may be offered COBRA. Failure to make premium payments may cause the employee (and covered dependents) to be uninsured. FMLA Statement of Policy 2018 Rev 0112 Page 3 of 6
Return to Work When an employee was out due to his/her own serious illness (or pregnancy), and he/she wants to return to work, they may be required to submit a completed Fitness for Duty Medical Certification Form or an authorized medical provider s formal medical note. When specified on the Designation Notice that a list of essential functions was attached and provided to the employee, the employee will then be required to provide to the employer an acceptable Fitness for Duty Medical Certification and the employee cannot return to work until an acceptable medical provider s note is received. Upon return to work, the employee will be restored to his/her prior position, or an equivalent position with equivalent pay, benefits and other terms and conditions, unless employment would have ended even if the employee had not been on leave (i.e., if the job were eliminated due to a staff reduction or reorganization). Failure to Return to Work Should an employee fail to return to work for at least 30 days at the end of the approved leave, he/she will be obligated to repay the Company for 100% of all premium payments paid by the Company on the employee s behalf during the unpaid portion of the leave. The Company will notify you in writing within 30 days of your failure to return to work, or sooner when applicable, to specify terms of premium repayment. The only exceptions are: (1) When the non-return is due to a continued serious health condition (medical certification required), or; (2) Other circumstances beyond the employee s control. The COO and/or CEO of the Company will make this judgment and the employee will be required to repay their portion of the premium, as would normally have been payroll deducted while actively employed. The Company will notify you in writing within 30 days of your failure to return to work, or sooner when applicable, to specify terms of premium repayment. Interference/Enforcement The FMLA makes it unlawful for any employer to: Interfere with, restrain, or deny the exercise of any right provided under the FMLA; Discharge or discriminate against any person for opposing any practice made unlawful by the FMLA or for involvement in any proceeding under or relating to the FMLA. An employee may file a complaint with the U.S. Department of Labor or may bring a private lawsuit against an employer for enforcement. FMLA does not affect any Federal or State law prohibiting discrimination, or supersede any State or local law or collective bargaining agreement which provides greater family or medical leave rights. Questions or Requests for Clarification Our FMLA policy is designed to provide a formal mechanism for prompt and orderly resolution of questions, complaints or disputes arising in the course of leave. Most issues can be settled informally in conversation with the Benefits & Insurance Department at 800-574-9829 / 402-891-0009. We encourage you to contact us with any questions or requests for clarification. Definitions BIRTH OF A CHILD: Leave for the birth of a child may include necessary prenatal care, or may begin before the actual day of birth of a child if the expectant mother s condition makes her unable to work. Leave for placement of a child may begin before the actual placement if an absence from work is required for the placement to proceed. CERTIFICATION: A certification that an employee is needed to care for a sick family member includes both physical and psychological care. It includes situations where the family member is unable to care for his/her own basic medical, hygienic, or nutritional needs or safety, and where providing psychological comfort will be beneficial to a seriously ill family member. CHILD: A child is described as a biological, foster or adopted child, a step child, legal ward, or a child of a person standing in loco parentis, who is under 18 years old, or is 18 or older and incapable of self-care because of a mental or physical disability. In loco parentis includes those with day-to-day responsibilities to care for and financially support a child. A biological or legal relationship is not necessary. CHILD / Military: Military provisions define a child as: a son or daughter on active duty or call to active duty status means the employee s biological, adopted, or foster child, stepchild, legal ward or a child for whom the employee stood in loco parentis who is on active duty or call to active duty status and who is of any age. This does not alter the definition or son or daughter for the purpose of leave for other FMLA-qualifying reasons. CHRONIC SERIOUS HEALTH CONDITION: A chronic serious health condition requires periodic treatment by a health care provider, or a nurse under direct supervision of a health care provider, that occurs at least twice a year. The health care provider must make the determination as to whether two treatments are necessary. Examples of serious health conditions include, but are not limited to: heart conditions, back conditions, respiratory conditions, FMLA Statement of Policy 2018 Rev 0112 Page 4 of 6
nervous disorders, arthritis, appendicitis, emphysema, and most cancers. EQUIVALENT POSITION: Defined as a position which has the same pay, benefits, and working conditions; involves the same or substantially similar duties and responsibilities which entail equivalent skill, effort, responsibility and authority; is available at the same or a geographically proximate work site where the employee had previously been employed; and is on the same or an equivalent work schedule. FITNESS FOR DUTY MEDICAL CERTIFICATION: A formal medical provider s documentation that certifies an employee can perform the essential functions of the position. Employers may also ask for fitness for duty certifications for intermittent leave every 30 days, but only when reasonable safety concerns exist. If initial certification, re-certification, or fitness for duty certification is incomplete or insufficient, the employer must notify the employee, in writing, of the deficiency and give the employee 7 calendar days to fix the deficiency. FMLA rights may be denied if deficiency is not cured. FOSTER CARE: Defined as 24-hour care for children in substitution for, and away from, their parents or guardian, in accordance with a placement made by, or in agreement with, the State. HEALTH CARE PROVIDER: For purposes of medical certification shall include doctors of medicine or osteopathy, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, state authorized nurse practitioners, nurse-midwives, and clinical social workers and Christian Science practitioners listed with the First Church of Christ Scientist in Boston, Massachusetts. NEXT OF KIN: For purposes of military caregiver leave, next of kin is defined as the service member s nearest blood relative, other than the service member s spouse, parent, son, or daughter, in the following order of priority: blood relatives who have been granted legal custody of the service member, brothers and sisters, grandparents, aunts and uncles, and first cousins, unless the service member has specifically designated in writing another blood relative as his/her nearest blood relative. PARENT: Defined as a biological parent, adoptive, step, or foster parent or someone w ho stood in place of a parent to an employee when the employee was a son or daughter. It does not include parents-in-law. Although some states allow an employee to take time off for other family members, the FMLA does not require family leave for a person in any other family relationship. PARENT / Military: Military provisions define a parent as: a biological, adoptive, step or foster father or mother, or any other individual who stood in loco parentis to the employee when the employee was a son or daughter. This term does not include parents in law. QUALIFYING EXIGENCIES: 1. Short-notice deployment: When the notice of an impending call or order to active duty is seven calendar days or fewer prior to the date of deployment. 2. Military events and related activities: To attend any official ceremony, program, or event sponsored by the military, or to attend family support and assistance programs and informational briefings sponsored or promoted by the military, military service organizations, or the American Red Cross that are related to the active duty or call to active duty status of a covered military member. 3. Childcare and school activities: To arrange childcare or to attend certain school activities for a son or daughter when the need arises due to active duty or the call to active duty. 4. Financial and legal arrangements: To make or update financial or legal arrangements to address the covered military member s absence. 5. Counseling: To attend counseling for the covered military member or their son or daughter when the need for counseling arises from the active duty or call to active duty of the covered military member. This provision in intended to cover counseling that is not already covered by the FMLA, such as counseling provided by a military chaplain, who does not meet the FMLA s definition of a health care provider. 6. Rest and Recuperation: To spend time with a covered military member who is on short-term, temporary rest and recuperation leave during the period of deployment. Eligible employees may take up to five days of leave for each instance of rest and recuperation. 7. Post-deployment activities: To attend arrival ceremonies, reintegration briefings and events, and an y other official ceremony or program sponsored by the military for a period of 90 days following the termination of active duty, and to address issues arising from the death of the covered military member while on active duty status. 8. Additional activities: The employer and employee can agree on other events that qualify for leave, and the timing and duration of such leave. FMLA Statement of Policy 2018 Rev 0112 Page 5 of 6
SERIOUS HEALTH CONDITION: Defined in detail in the regulations. Generally, it includes an illness, injury, impairment, or physical or mental condition that involves: 1. Any period of incapacity or treatment in connection with or consequent to inpatient care (i.e., an overnight stay) in a hospital, hospice, or residential medical care facility. 2. Any period of incapacity requiring absence from work, school, or other regular daily activities of more than 3 consecutive, full calendar days, that also involves continuing treatment by a health care provider. Continuing treatment involves either 2 visits to a health care provider or 1 visit and a regimen of continuing treatment. The 2 visits must occur within a 30-day period that begins with the first day of incapacity. The first visit must occur within 7 days of the first day of incapacity, absent extenuating circumstances that prevent the follow-up visit from occurring as planned by the health care provider (e.g., there are no available appointments during the 30-day period). Where the employee s serious health condition involves one visit to a health care provider, plus a regimen of continuing treatment, this one visit must also occur within 7 days of the first day of incapacity. 3. Continuing treatment by a health care provider for a chronic or long-term health condition that is incurable or so serious that, if not treated, would likely result in a period of incapacity of more than 3calendar days or for prenatal care. A chronic serious health condition requires periodic treatment by a health care provider or a nurse under direct supervision of a health care provider that occurs at least twice a year. The health care provider must make the determination as to whether two treatments are necessary. Examples of serious health conditions include, but are not limited to: heart conditions, back conditions, respiratory conditions, nervous disorders, arthritis, appendicitis, emphysema, and most cancers. SPOUSE: Defined as a husband or wife as recognized under state law for purposes of marriage in the state where the employee resides. It includes common law marriages in states where it is recognized, but does not include unmarried domestic partners. The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of employees or their family members. In order to comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. Genetic information, as defined by GINA, includes an individual s family medical history, the results of an individual s or family member s genetic tests, the fact that an individual or an individual s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual s family member or any embryo lawfully held by an individual or family member receiving assistive reproductive services. FMLA Statement of Policy 2018 Rev 0112 Page 6 of 6