STD/FMLA Training- Oakland University May 7, 2013 Tom DeSimone, Director Client Solutions Lisa Nowland, Account Manager

Transcription

1 STD/FMLA Training- Oakland University May 7, 2013 Tom DeSimone, Director Client Solutions Lisa Nowland, Account Manager

2 TOPICS TO BE COVERED Family and Medical Leave Act (FMLA) 101 Eligibility Entitlement Federal Landscape Employer/Employee Responsibilities FMLA and Disability Cigna Process 2

3 UNDERSTANDING FMLA 3

4 FMLA USE ON THE RISE 17% took FMLA 1 24% were Intermittent Leaves 1 Sandwich generation own illness, child care and now elder care Aging workforce older workers absences can be up to 1/3 longer Higher rates of chronic disease cardiac, stroke, cancer, diabetes, arthritis Greater employee awareness of FMLA particularly intermittent leaves 1 - US Department of Labor RFI - FMLA 2007 Update; 2 - U.S. Census Bureau, December

5 THE FAMILY AND MEDICAL LEAVE ACT (FMLA) Federal Law Allows employees to take unpaid time off for qualifying events Applies to private employers with 50 or more employees Provides employees with job protection Maintain health insurance coverage Enacted in

6 THREE CRITERIA FOR ELIGIBILITY 1. Work in the U.S. or a U.S. territory 2. Worked a minimum 12 months 3. Worked at least 1,250 hours in the 12 months preceding the leave 6

7 WHAT EVENTS QUALIFY UNDER FMLA? An employee s own serious health condition Family member with serious health condition Birth or care of newborn Adoption or foster care Family member injured while on military duty FMLA defines family member as: spouse, child, parent 7

8 SERIOUS HEALTH CONDITION An illness, injury, impairment, or physical or mental condition that involves either: Inpatient care in a hospital, hospice, or residential medical-care facility, and related treatment Continuing treatment that includes incapacity of 3+ consecutive, full days Subsequent treatment: 2+ times within 30 days of the first day of incapacity Continuing regimen Pregnancy/prenatal care Chronic health condition (e.g. asthma, diabetes) Permanent or long-term condition (e.g. Alzheimer s) Multiple/restorative treatments (e.g. chemotherapy) 8

9 HOW MUCH TIME CAN AN EMPLOYEE TAKE? Up to 12 workweeks to care for self or immediate family member Up to 26 workweeks to care for family member ill/injured while on military duty Available leave time = hours in employee s workweek x 12 weeks For example: 40 hours X 12 weeks = 480 hours available 9

10 TWO TYPES OF LEAVES Continuous Intermittent Periodic time off Medically necessary Military leave reasons If FMLA leave is for birth and care or placement for adoption or foster care, use of intermittent leave is subject to the employer's approval 10

11 HOW IS INTERMITTENT LEAVE TIME DEFINED? Have doctor certify: Frequency Duration Greg: Suffers from asthma Frequency: Up to 3 times/month Duration: Up to 4 hours per occurrence Unscheduled time Mary: Undergoing chemotherapy Frequency: 1 time/week Duration: 8 hours Scheduled treatment 11

12 EMPLOYEE RESPONSIBILITIES: MEDICAL CERTIFICATION Doctor substantiates the need for leave 15 days to submit 7 days to fix and resubmit if deemed incomplete May need to provide: 2nd or 3rd medical opinions Return to work intent and status 12

13 Managing Family Medical Leaves Reporting a Leave Eligibility Notification Standalone Family Medical Leave Disability/Family Medical Leave Intermittent Time Tracking Keeping You Informed 13

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15 Integrated Intake- Disability and FMLA One Phone Call Toll-free number Spouse or manager can report the leave on employee s behalf 15

16 Intake Process Employees work with expert, trained team: Knows company policies Knows regulations Knows leave eligibility Knows what questions to ask 16

17 One Call Validate eligibility data Reason for Leave Start & end dates Continuous or intermittent Communicate Time Available 17

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19 Eligibility Notification Explain how other leave plans work with FMLA Integrated eligibility letter Rights & Responsibilities under FMLA Medical certification Mailed in 5 business days in compliance with FMLA Determination Notification to Employer STD & FML Jane Smith Leave Manager CIGNA Leave Solutions P.O. Box Dallas, TX Phone: Fax: March 7,2008 Plan/Policy Number: SDH Plan/Policyholder: ABC Company Administered by: CIGNA Leave Solutions Re: Leave Status Determination Notification Donald Jones Leave ID#12345 This letter is regarding Donald Jones s request for STD/FMLA of absence due to Employee s own serious health condition The following determination(s) have been made under applicable Federal and/or State Family Medical Leave (FML) laws and/or a company leave policy: Plan From Through Status Reason STD 05/05/ /15/2008 Approved EE s Serious Health condition FMLA 05/05/ /05/2008 Approved EE s Serious Health condition Plan Time Used * Time Remaining* STD 5 Days FMLA 40 Hours 300 Hours 19

20 Leaves take one of two paths: disability and family medical concurrent leaves or standalone family medical leaves Determine leave path Disability decision drives family medical leave (FML) approvals when these two leave types run concurrently Concurrent STD-FML Family Medical Leaves When leave reason is concurrent STD and family medical leave, disability claim manager coordinates with other resources. When leave reason is family medical leave only, leave manager is single point of contact. Verbal authorization results in quicker claims decisions. Claim manager immediately begins conversations with the customer and client to develop a return-towork plan. Leave manager works with customers to ensure they follow the medical certification process as outlined by regulations. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna 20 20

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22 FML standalone path: Skilled resources guiding you and your employees at every step Standalone FML Attorney and compliance experts Leave manager Dedicated FMLA nurses Leave managers Experts in regulations who strive to know clients and their culture to help personalize the experience for employees. They ensure leave information is properly communicated to employees and their managers in a timely manner. Attorney and compliance experts Ensure leaves are administered in accordance with federal and state regulations, eliminating compliance risks Vocational counselors FMLA nurses Consult on complex diagnoses, review absence patterns and serve as the liaison with the treating doctor; aware of what is allowed under the regulations Vocational counselors Provide dedicated support to help employees on FMLA leave remain productive through workplace modifications Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna 22

23 Standalone Family Medical Leave Medical Certification Critical data required for: Family medical leave Must be completed by doctor Return within 15 calendar days Form will be sent directly to the employee and is also available on the CIGNA website 23

24 Standalone Family Medical Leave Medical Certification Reviewed for completeness 7 days to cure for deficiencies Clinical Outreach 24

25 Standalone Family Medical Leave Leave Review Approve or deny leave Letter communicates to employee the leave decision Human Resources will also receive an communication of the decision Recertification 25

26 Standalone Family Medical Leave Notification when family medical leave time is used up Human Resources will receive an notification Employees who have exhausted their FML, may be eligible for additional leaves and will be directed to contact CIGNA and their Manager 26

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28 Leave/Claim Review Disability approval drives family medical leave decision If the disability claim approved, family medical leave is automatically approved Leverage quick STD decision times to approved FML absences Communications are integrated 28

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30 Standalone Family Medical Leave Intermittent Can take time periodically Frequency and duration Scheduled or unscheduled 30

31 Specialized intermittent leave support Designed to ensure compliance and minimize workplace disruption. Tracks time down to one-minute increments. Clinical review Set expectations Immediate decision Patterns monitored Clinical case oversight Monitor complex diagnoses Obtain 2nd/3rd opinions as necessary Referrals to health improvement programs Proactive employee outreach on all approved intermittent leaves to review company s timereporting procedures and set expectations Team of leave managers to handle time-off requests Every time-off request is reviewed to certify frequency and duration Decision is made during the call and immediately communicated to managers Leave Manager monitors absence patterns and recertifies, if needed All leaves recertified at six months Optimize workforce productivity Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna 31 31

32 Potential FML Abuse Situations Coordinated Approach Employees savvy regarding FML and ADA process Suspicious patterns of abuse are identified (Intermittent Tracking Team, Leave Manager, Certification Reviews, FML Systems Support) if the employer receives information that casts doubt upon the employee s stated reason for the absence or the continuing validity of the certification Internal Processes. Claim escalated (Leave Manager, Senior Leave Manager, Team Leader) Resources engaged for medical review It is permissible to contact the employee to discuss the pattern of absence prior to requiring recertification If all signs lead to a pattern of abuse Cigna Leave Solutions will manually send a recertification packet to the employee and follow our normal process for recertifying the leave. If there is a corresponding STD claim the Leave Manager will communicate with the STD Claim Manager and designated return to work resource. The SIU may be engaged at this time (70% concurrent) External Process Cigna will correspond with you regarding an inappropriate leave to potentially initiate any OU internal processes 32

33 Intermittent Time Tracking Intermittent tracking a challenge We track time for you down to 6-minute increments Employee should report time taken to CIGNA and their manager Update medical certification 33

34 Questions??? CIGNA, and the Tree of Life logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries and not by CIGNA Corporation. Such operating subsidiaries include Life Insurance Company of North America, CIGNA Life Insurance Company of New York, and Connecticut General Life Insurance Company / CIGNA Images 2010 Thinkstock. All rights reserved. 34