Coverage During a Leave of Absence

If you are approved for a leave of absence without pay, you can continue to participate in your MCHCP plan. You are billed for the full cost of the coverage for yourself and your eligible dependents unless your leave of absence is due to Workers’ Compensation (WC) or under the Family Medical Leave Act (FMLA). If your Leave of Absence is due to Workers’ Compensation or FMLA, talk with your human resources/payroll office to see that the proper forms have been filed with MCHCP.

MCHCP will not continue your coverage (medical, vision, and/or dental) unless you elect to have it continued. Prior to your leave, you may elect to continue coverage by completing and signing Continuation of Coverage During Leave (M-3) form. If you do not complete the Continuation of Coverage During Leave (M-3) form, you are sent a letter asking if you want to continue coverage while you are on leave. If so, you can sign the letter and return it to MCHCP within ten days. If, after electing to continue coverage while on leave, you fail to pay the premium due, coverage on you and your dependents is terminated. You are not allowed to enroll in the plan again until the Open Enrollment following your return to work.

If you maintain coverage for yourself but not your covered dependents you are eligible to regain coverage for your dependents when you return to work. However, if you participate in the Copay Plan, the pre-existing condition limitation applies if more than 63 days has lapsed between coverage. This does not apply if you are a participant in an HMO.

If you do not elect to continue your insurance, coverage for yourself and/or your dependents is suspended effective the last day of the month in which you are an active employee. In order for your coverage to be reinstated when you return to work, you must complete the Change/Cancellation (M-2) form within 31 days. Your coverage is reinstated on the first of the month following the date your form is received. You may regain the same level of coverage you had with the plan in which you were enrolled prior to the leave. However, if you participate in the Copay Plan, the pre-existing condition limitation applies if more than 63 days has lapsed between dates of coverage. This does not apply if you participate in an HMO.

If you are an active State subscriber and are placed on Leave Without Pay or Layoff status and are also the spouse of a State subscriber (either active or retired), you may choose to be covered under your spouse. You are not required to wait until Open Enrollment to make the change. If, at a later date, you wish to be covered individually, you can make that change as long as the coverage is continuous. A subscriber transferring under a spouse’s coverage is enrolled in the plan in which the spouse is enrolled. When you return to work, you and your spouse must be covered individually.

Leave of Absence - Workers’ Compensation
If you are on a leave of absence due to illness or injury and you are receiving weekly Workers’ Compensation (WC) benefits, the normal monthly contribution toward your medical coverage continues. You are responsible for the premium payments that were normally deducted from your payroll prior to your leave of absence.

Medical coverage is extended to you during the time period in which you are receiving weekly WC benefits. Once you are no longer eligible for the weekly WC benefits, you are responsible for paying the applicable monthly Leave of Absence rate for your medical coverage, unless you return to active State employment. When your status changes from WC to Leave of Absence, you may elect to suspend coverage. If coverage is suspended, at that time, you may re-enroll within 31 days of your return to work.

Leave of Absence - Family Medical Leave
If you are approved for a leave of absence under the Family Medical Leave Act of 1993 and have met the requirements and guidelines set forth by the FMLA law and your employing agency, the State continues to pay its monthly contribution toward you and your dependents’ coverage. You are responsible for the premium payments that were normally deducted from your payroll prior to your leave of absence. At the end of your FMLA leave, if you are still unable to return to work, you may elect to suspend your coverage. If coverage is suspended at that time, you can enroll within 31 days of your return to work.