Coverage for employee on extended unpaid leave and unable to return to work

[waid10]

Hi. I am hoping someone point me in the right direction. We have an employee out on extended unpaid leave. I am told that due to the ACA, the Employer must keep the employee on our health plan indefinitely even in a situation where the employee cannot work due to his own health condition and he is on extended unpaid leave following FMLA.

Thanks.

[GMK]

My understanding is that under ADA, after the end of an FMLA leave, you need to discuss a continuing health issue with the employee to try to determine if a reasonable accommodation is possible. If it is, then you provide the reasonable accommodation. If it isn't, then you proceed consistent with ADA and your company's policies.

Continuation of coverage under the company health plan may or may not be reasonable accommodation, depending on the specific circumstances, past practices, etc.

I do not know of anything in ACA that requires continued coverage beyond that provided under FMLA, but I don't know everything about ACA. Maybe someone else can help there.

[taxllm]

The answer depends if the employee is on STD/LTD that is not paid entirely on an after-tax basis by the employee and also on whether you use the look-back method to determine eligibility for your group health coverage.

If you use the look-back method and the employee is on a stability period, you keep the coverage on until the end of the stability period (as long as the individual is still an employee). At the end of the stability period, you look back at the measuring period and determine if the employee had enough hours to be eligible again for coverage. Be careful of the special rules regarding FMLA leave, STD/LTD when measuring hours during the measuring period.