Is The Employer Required To Maintain Dental Coverage During FMLA Leave?

The federal Department of Labor (DOL) has issued an opinion letter to a school district stating that the dental coverage it provides its employees must be maintained during FMLA leave, the same as group health coverage is.  The Family and Medical Leave Act (FMLA) and its regulations require employers to maintain any “group health plan” coverage to an eligible employee on leave under the same conditions as coverage would have been provided if the employee had been continuously employed during the entire leave period.  For example, if the employer contributes 75% of the insurance premium while employed, it must pay that amount while the employee is on FMLA leave.

The school district which sought the advice from the DOL offers a group health insurance plan that provides medical care coverage for instructional employees and separately offers a group dental insurance plan for these employees.  The district pays 100% of the dental insurance premiums up to a maximum amount per month.  The district did not want to continue paying for dental coverage for its employees on FMLA leave, contending that such coverage is not a group health plan under the FMLA.  The school district argued that that the dental plan is not a part of, or a supplement to, its “group health plan,” but rather, is a separate group dental program and therefore not subject to FMLA coverage.

In its opinion letter, the DOL ruled that the district’s dental plan did come within the broad definition of “group health plan” under the FMLA regulations.  The pertinent regulation states:

“benefit coverage during FMLA leave for medical care, surgical care, hospital care, dental care, eye care, mental health counseling, substance abuse treatment, etc., must be maintained during leave if provided in a group health plan, including a supplement to a group health plan.”

FMLA does provide for an exclusion from the coverage requirement for plans where employees purchase individual insurance policies through their employer but the DOL determined that the district’s dental plan did not fit under this exception because the district paid 100% of the dental premium, negotiated the cost of the premiums and employed a claims administrator to handle disputed claims.  (Emphasis added)

This opinion letter points out to employers that the requirement that group health plan coverage be continued during FMLA leave does not just refer to major medical coverage but can include dental and vision care and the like.  The exception to this would be when an employer merely acts as a conduit for certain coverage – offering the insurance to employees under payroll deduction as a convenience but not contributing any part of the premium.

If you have any questions regarding FMLA leave or a specific instance in your workplace that you need guidance on, HR-OneSource can provide help.  Please contact David L. Hansen, SPHR, CCP at (515) 221-1718 or hansend@hr-onesource.com.