Leave Under the Family and Medical Leave Act (FMLA) If you have worked for BCBSAZ a minimum of one year, are employed at a worksite where 50 or more employees are located within 75 miles of the worksite, and have worked 1,250 hours or more during the 12 months prior to commencement of the leave, you may be eligible for leave under the Family and Medical Leave Act ( FMLA ). The following family leave policy highlights some of the key provisions of the Act. To the extent that the following policy conflicts with the Act or does not address all of BCBSAZ s or the employee's rights under the Act, the terms of the Act will control. While on leave, you are eligible to continue medical benefit coverage and most employees will be entitled, upon completion of the leave, to restoration to their original or equivalent position. When you take leave in accordance with this policy, it will be counted against your annual FMLA leave entitlement. Effective February 15, 2010, BCBSAZ will outsource processing of FMLA leave requests to a third-party FMLA Administrator. However, BCBSAZ s Human Resources Department remains available to answer questions about the FMLA leave process, including questions about the FMLA Administrator. As of February 15, 2010, the Company will use FMLASource as its FMLA Administrator. For more information regarding FMLASource, including contact information, please see Section F, Notification. Note: Employees who work at locations that are not large enough to qualify for coverage under the FMLA (e.g., Flagstaff) may apply for a 6 week leave of absence offered by BCBSAZ. A. Basic Leave Entitlement If you are eligible for leave, you will be allowed up to 12 weeks of unpaid leave within any 12 month period for the birth, adoption or foster care placement of a child, to provide either physical or psychological care for a child, spouse or parent with a serious health condition, or to care for your own serious health condition which makes you unable to perform any one or more of the functions of your job. Leave for the birth or placement of an adoptive or foster care child must be completed within 12 months after the event. Leave may begin prior to birth or placement, as circumstances dictate. BCBSAZ uses the rolling backward method for determining the 12-month period in which the leave entitlement occurs. Under this method, the 12-month period is measured backward from the date an employee uses any FMLA leave.
B. Military Family Leave Entitlements Qualifying Exigency: Eligible employees with a spouse, son, daughter, or parent on active duty or call to active duty status in the Armed Forces, National Guard, or Reserves 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. BCBSAZ uses the rolling backward method described above for determining the 12- month period in which entitlement to qualifying exigency leave occurs. Military Caregiver Leave: Eligible employees may also take up to 26 weeks of leave to care for an employee s spouse, child, parent, or next of kin (nearest blood relative) who is a covered service member during a single 12-month period. A covered service member is a current member of the Armed Forces, National Guard, or Reserves, who has a serious injury or illness incurred or aggravated in the line of duty on active duty. Covered service member also includes veterans who were members of the Armed Forces, National Guard, or Reserves at any time during the period of five (5) years preceding the start of treatment, recuperation, or therapy. The injury or illness must make the service member medically unfit to perform his or her duties for which the service member is undergoing medical treatment, recuperation, or therapy; or is in outpatient status; or is on the temporary disability retired list. In the case of a veteran, the qualifying illness or injury must be incurred or aggravated in the line of duty and manifest itself before or after the service member became a veteran. Eligible employees are entitled to a total of 26 weeks of unpaid Military Caregiver Leave during a single 12 month period. This single 12-month period begins on the first day an eligible employee takes Military Caregiver Leave and ends 12 months after that date. The Military Caregiver Leave entitlement applies on a per-covered service member, perinjury basis. However, no more than 26 weeks of leave may be taken within a single 12- month period by any covered employee. C. Intermittent or Reduced Leave Intermittent leave is leave taken in separate blocks of time due to a single qualifying reason. Reduced leave is leave that reduces an employee s usual number of hours per week or hours per weekday. In the case of your own serious health condition or a family member s serious health condition, you may take leave intermittently or on a reduced work schedule, if medically necessary. When the leave is for adoption or birth of a child, you may take leave intermittently or on a reduced work schedule only with the joint approval of you and BCBSAZ. Military Caregiver Leave may be taken intermittently or on a reduced leave schedule when medically necessary. Intermittent leave may also be available for a qualifying exigency regarding a relative s active military duty.
If you request intermittent or reduced leave status, BCBSAZ may temporarily transfer you to another position of equivalent pay and benefits in order to better accommodate your leave. D. Use of Paid Time-Off Benefits You may request or be required by BCBSAZ to substitute paid time off benefits, such as accrued vacation, for your unpaid FMLA leave. BCBSAZ s sick/short-term disability leave policies may limit your ability to substitute paid time off benefits. Using paid time off benefits does not add to the total length of the leave. Unless you substitute paid time off benefits, your pay will be reduced for all full days of unpaid leave taken or, if less than a full day is taken, for each fifteen minutes of leave taken within a single day. E. Leave Provisions for Spouses Both Working for the Organization If BCBSAZ employs both a husband and wife who are both eligible for FMLA leave, the spouses are eligible for a combined total of 12 weeks of leave when leave is due to the birth or placement of a child. When leave is due to Military Caregiver Leave, the spouses are eligible for a combined total of 26 weeks of leave. A husband and wife may not take more than a combined total of 12 weeks of leave for the birth or placement of a child. If leave is taken to care for an ill child, parent, or spouse, or for the employee's own serious health condition, each employee is entitled to 12 weeks of leave. Similarly, if one spouse takes leave to care for the other during Military Caregiver Leave, then the spouse requesting leave is entitled to 26 weeks of leave. F. Notification Employees must notify the FMLA Administrator of their need for family medical and/or family military leave. Effective February 15, 2010, the FMLASource will serve as the Company s FMLA Administrator. To contact FMLASource, please call 877.GO2.FMLA, or visit them online at www.fmlasource.com. For additional information regarding FMLASource, please contact the Human Resources Department or visit the Leave Section of the BCBSAZ Intranet. When leave is foreseeable, you must provide the FMLA Administrator with at least 30 days advance notice. When leave is expected, you must make reasonable effort to schedule the leave so as to not disrupt company operations. When 30 days advance notice is not possible, you must provide the FMLA Administrator with notice as soon as practicable. Failure to notify the FMLA Administrator may result in a delayed start of your FMLA leave. You can request FMLA leave by calling, faxing, and/or e-mailing the FMLA Administrator.
If you are physically unable to contact the FMLA Administrator regarding your leave, please contact Human Resources for assistance. If leave is taken for a FMLA qualifying-reason and is not designated as FMLA leave by BCBSAZ and/or its FMLA Administrator, you must notify the FMLA Administrator within two business days of returning to work that the leave was for a FMLA reason. If you do not timely notify the FMLA Administrator of the reason for the absence, you may not subsequently assert FMLA protection for the absence. G. Certification If you request leave for your own serious health condition or that of a family member, BCBSAZ requires health care provider certification. You will have 15 days to return a completed Certification form once you receive the form from the FMLA Administrator. This certification should include the following: - The start date of the condition - The probable duration of the condition - The appropriate medical facts from the health care provider regarding the condition - If for a spouse, child or parent, a statement that the employee is needed to care for that family member and an estimate of the time period - If for the employee, a statement that he or she is unable to perform the job functions - If for intermittent or reduced leave of absence, a statement of the medical necessity and expected duration of such leave The commencement or continuation of your leave may be delayed until you submit proper certification. Similarly, your leave may not be designated as FMLA leave if certification is not submitted. Further, if the FMLA Administrator determines that your Certification form is incomplete or insufficient, you will receive written notice of the additional information needed and will have 7 days to provide the necessary information. In some circumstances, BCBSAZ and/or its FMLA Administrator may require, at their expense, a second opinion regarding the health condition in question. If the original certification and the second opinion differ, BCBSAZ and/or its FMLA Administrator may require a third opinion, also at their expense. You and BCBSAZ and/or its FMLA Administrator will jointly select the third health care provider. The third health care provider s opinion will be final and binding.
A request for Qualifying Exigency leave must be supported by the Certification of Qualifying Exigency for Military Family Leave form as well as appropriate documentation, including the covered military member s active duty orders. A request for Military Caregiver Leave must be supported by the Certification for Serious Injury or Illness of Covered Servicemember form as well as any necessary supporting documentation. You will have 15 days to return the completed Certification form once you receive the form from the FMLA Administrator. Please contact the FMLA Administrator to obtain the necessary forms. H. Recertification Under certain circumstances, including (but not limited to) situations in which the need or nature of your approved leave changes, BCBSAZ and/or its FMLA Administrator may, in their discretion, require recertification of your serious health condition. BCBSAZ and/or its FMLA Administrator may also request recertification every year in which FMLA Leave is taken for any serious health condition that lasts longer than one (1) year. In these situations, you will have 15 days to provide a completed Recertification form. I. Employee Benefits Your group health insurance benefit will continue during your leave. Both BCBSAZ and you will continue to pay the customary portions of the monthly premium. If you fail to make timely payments, your coverage may be terminated. BCBSAZ may also choose to make premium payments on your behalf to continue your coverage. If BCBSAZ makes your premium payments during your leave, BCBSAZ may recover the amount of premium paid from you at the end of your leave, whether or not you return to work. You may pay your portion of health insurance benefits by continuing the payroll deduction using Paid Time Off (PTO) to supplement leave, or by paying the premium contributions for the period of unpaid absence upon returning to work. The payroll system will automatically track, and upon your return to work recoup, all missed deductions. The system will recoup one and one half times your normal deductions each pay period until BCBSAZ has recovered all missed premiums. J. Return to Work Employees on FMLA leave must periodically inform the Human Resources Department and/or the FMLA Administrator of their status and intent to return to work following expiration of their approved FMLA leave. Employees returning from FMLA leave must be able to assume all essential functions of their jobs upon return. If you took FMLA leave for your own serious health condition, then you must provide, upon request, certification from your health care provider stating that you are able to resume work. Unless otherwise required by law, an employee granted FMLA leave who fails to return to work upon expiration of leave shall be classified as voluntarily terminated.
K. Job Restoration Employees granted leave, and who return to work at the end of the authorized leave period, will generally be returned to the same position held prior to the leave, or a different position that is equivalent in pay, benefits, and other terms and conditions of employment. Exceptions to such restoration include, but are not limited to, changes in the work force such as reductions-in-force or elimination of positions/departments such that BCBSAZ no longer has positions available for which the employee would be entitled if the employee had not taken leave. BCBSAZ may deny job restoration, in certain circumstances, to "key" employees. Generally, key employees are salaried employees who are among the highest paid 10 percent of employees at a facility. Upon requesting FMLA leave, BCBSAZ and/or its FMLA Administrator will notify you if you are a key employee and if BCBSAZ may deny reinstatement following leave. L. Additional Information If you have any questions or would like additional information about FMLA leave entitlements, procedures, the FMLA Administrator, or related issues, please contact the Human Resources Department.