FMLA

[KDM74 186]

So, I knew that most of the plastics I will need/want aren't covered by insurance, but I never even considered that leave for surgery would not be covered under FMLA. Does anyone have experience with this? My entire department is being bought by a large national company in September and I am hoping to be able to have plastics done in the fall of 2016, but I can't take the chance that they will not hold my job for a month and that I won't be covered by insurance! I need to know some personal experiences with this please. I am trying to plan way ahead and know what to expect / battles that will need fighting. Thanks!

[BLERDgirl 6,417]

It varies from state to state how is will be administered. Here in Philadelphia some employers hold a job unless it is a in demand position. You may want to schedule an appointment with your employer's HR department and get in writing what your company's policy is.

[ladycook9713 442]

You need to call the provider for your FMLA, and find out if it is covered. If it is then there is absolutely nothing that your employer can do. If you take FMLA time to cover the off time from work then they have to hold the position during the time that you are out. Period. The End. If they do not hold your position for the time you are out (only time covered by FMLA) then you have a law suit on your hands.

[no onions 258]

@@KDM74

Who told you it wasn't covered? That would be like your employer not covering you for WLS surgery if you were self-pay. I don't think they need to know what specifically you're having done - if a Dr. indicates that you need to be out for recovery then I do not understand why you couldn't take advantage of FMLA. I think there are exceptions for really small companies/businesses.

Let us know what you find out.

[KDM74 186]

The FMLA law states that cosmetic surgery is not typically covered. But then it says that if you have something requiring an inpatient stay, it is covered. I have also read on realself that most plastic surgeons say it's not covered.

I'll have to check with HR once we transition over there. Thanks.

[Jersrose43 837]

Final is a federal legislation and it is NOT up to your employer. Here is the legislation

Employees can take job-protected leave under the Family and Medical Leave Act (FMLA) for serious health conditions. But the U.S. Department of Labor's FMLA regulations say, “conditions for which cosmetic treatments are administered (such as most treatments for acne or plastic surgery) are not ‘serious health conditions’ unless inpatient hospital care is required or unless complications develop.” (FMLA 29 C.F.R. § 825.113(d))

[Jersrose43 837]

From the U.S. Department of Labor's regulations relating to the Family and Medical Leave Act (FMLA 29 C.F.R. § 825.113):

(a) For purposes of FMLA, “serious health condition” entitling an employee to FMLA leave means an illness, injury, impairment or physical or mental condition that involves inpatient care as defined in §825.114 or continuing treatment by a health care provider as defined in §825.115.

( The term “incapacity” means inability to work, attend school or perform other regular daily activities due to the serious health condition, treatment therefore, or recovery therefrom.

© The term “treatment” includes (but is not limited to) examinations to determine if a serious health condition exists and evaluations of the condition. Treatment does not include routine physical examinations, eye examinations, or dental examinations. A regimen of continuing treatment includes, for example, a course of prescription medication ( e.g. , an antibiotic) or therapy requiring special equipment to resolve or alleviate the health condition ( e.g. , oxygen). A regimen of continuing treatment that includes the taking of over-the-counter medications such as aspirin, antihistamines, or salves; or bed-rest, drinking fluids, exercise, and other similar activities that can be initiated without a visit to a health care provider, is not, by itself, sufficient to constitute a regimen of continuing treatment for purposes of FMLA leave.

(d) Conditions for which cosmetic treatments are administered (such as most treatments for acne or plastic surgery) are not “serious health conditions” unless inpatient hospital care is required or unless complications develop. Ordinarily, unless complications arise, the common cold, the flu, ear aches, upset stomach, minor ulcers, headaches other than Migraine, routine dental or orthodontia problems, periodontal disease, etc. , are examples of conditions that do not meet the definition of a serious health condition and do not qualify for FMLA leave. Restorative dental or plastic surgery after an injury or removal of cancerous growths are serious health conditions provided all the other conditions of this regulation are met. Mental illness or allergies may be serious health conditions, but only if all the conditions of this section are met.

[KDM74 186]

Yes, I have read the law. That still doesn't answer my question. The plastics I want WILL require at least a 1 night stay in the hospital... so does that mean it qualifies for FMLA? I would really love to hear from someone who has been through the process, either way, so that I would have an example.

[Jersrose43 837]

Ask your surgeon if you will be impatient as per last paragraph. Not just overnight. That can be outpatient. And has to be a full fledged hospital too

[BethinPA 305]

I can't speak to the law. I just crossed my fingers when applying for mine, and my boss granted it. My co-worker got a Tummy Tuck that did not require a night in the hospital, and she asked her surgeon's staff to just describe her surgery as abdominal surgery. I don't think your employer must know the true specifics of what you are having done, merely that you have a condition that requires surgery, and that you will need x amount of time for recovery.

[ladycook9713 442]

Employer isn't who determines if it is eligible or not. The FMLA provider does.

You don't have to tell your employer what you're doing. You're not required by law to. You can describe it as surgery if you want. They may approve the initial request. But it is up to the FMLA provider (in my case Fidelity) to actually approve the time off. You will have to tell them what you are having done I believe.

I'm just going off my experience for maternity leave. I was going to take FMLA for my sleeve surgery as well, but it hasn't been a year since I had, had my daughter, and I didn't have any full paid FMLA time still.

[BethinPA 305]

Everything had to be approved by the human resources department of my employer. There was no third party, in my case. There was a third party for short term disability insurance, but that's a totally different subject.

[Jersrose43 837]

Everything had to be approved by the human resources department of my employer. There was no third party, in my case. There was a third party for short term disability insurance, but that's a totally different subject.

Most non maternity medical leaves go to short term disability. Many maternity ones do as well. Just FYI.

The carrier will review the request under regular fmla first then if you don't qualify for fmla you get reviewed under short term disability.

Fmla is activated after 1250 hours of work.

I had an employee going through oncology treatment and had one paid fmla at the beginning of the year and a short term medical disability at the end of year. I was told by hr with the second one I could post her position and hire a replacement. I didn't. She was out for 4 months. That's the benefit of fmla protect your rights.

[Sharon1964 2,530]

I think some people are confusing FMLA leave with disability insurance. FMLA gives you the right to take off work and have certain protections.

Disability insurance may or may not pay for that time off.

There is no "FMLA provider".

[Jersrose43 837]

I think some people are confusing FMLA leave with disability insurance. FMLA gives you the right to take off work and have certain protections.

Disability insurance may or may not pay for that time off.

There is no "FMLA provider".

And we have a winner! Couldn't agree more!