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FAMILY MEDICAL LEAVE OF ABSENCE by S888vInM

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									                                                                               Policy V. 185
                                                                               1st Effective 7-16-12
                                                                               Revised
              University Health Associates
                         Ambulatory Services
                POLICY AND PROCEDURE MANUAL                                    Reviewed




                              FAMILY MEDICAL LEAVE OF ABSENCE


A. AVAILABILITY OF FMLA LEAVE

University Health Associates (UHA) will administer leaves of absence that qualify under the Family
Medical Leave Act (FMLA) in accordance with the FMLA and the regulations of the Department of Labor,
Wage and Hour Division (DOL Regulations), as each may be amended from time to time. As such, this
Policy is in all respects subject to, and is designed to comply with and to be interpreted in accordance with,
the requirements set forth in the FMLA and the DOL Regulations.

B. QUALIFYING REASONS FOR FMLA LEAVE

FMLA may be taken for the following reasons:

      1. The birth or adoption of a child
      2. The placement of a foster child
      3. The employee’s own serious health condition
      4. To care for a family member with a serious health condition
      5. Covered Servicemember Leave and Active Duty Leave

C. ELIGIBILITY FOR FMLA LEAVE

A leave of absence under the FMLA is available when a full-time or part-time employee or a member of
the employee’s family suffers a “serious health condition” or has another qualifying reason for an FMLA
leave as described in this Policy. In order to be eligible for an FMLA leave, the employee must have
worked at least twelve (12) months for UHA, and must have worked at least 1,250 hours, during the
previous (12) month period from the date the FMLA leave begins. Note: Paid leave time such as
vacation, personal and sick leave hours are not counted toward hours worked for purposes of determining
eligibility.

D. AMOUNT OF FMLA LEAVE TIME AVAILABLE

In most cases, the maximum leave time available to an employee is twelve (12) weeks in a 12-month
period. The 12 month period in which an employee may take an FMLA leave for intermittent absences
begins on the date of Unum’s approval, and counting forward 12 full months from that date.

The 12 month period in which an employee may take an FMLA leave for a continuous absence begins on
the first day of the actual leave, and counting forward 12 full months from that date.

A leave due to the birth of a child, adoption of a child or placement of a child in foster care must be
completed within the 12-month period beginning on the date of birth, adoption or placement. If the
employee’s spouse is employed by UHA, and the spouse also requests a leave for the birth, adoption or
placement of a child, then both spouses are permitted to take FMLA leave, however they may not take
more than a combined total of 12 weeks of leave.
Employees who are family members of "covered servicemembers" are entitled to take up to 26 workweeks
of leave to care for a covered servicemember (meaning a spouse, son, daughter, or parent, or other next of
kin) with a serious illness or injury incurred in the line of duty while on active duty, as further described
below.

Eligible employees with a “covered military member” may take up to 12 workweeks of FMLA for
activities arising from a covered military member’s active duty or call to active duty status to service in a
foreign country, as further described below.

If the employee’s leave is related to a workers’ compensation injury, the workers’ compensation leave and
FMLA leave shall run concurrently.

E. USE OF PAID DAYS OFF AND SHORT TERM DISABILITY

Employees are required to use up to 16 hours of Paid Days Off (PDO) for the first sixteen hours of any
continuous approved FMLA absence or intermittent FMLA unless they meet the exceptions to immediate
access under the Short Term Disability (STD) policy. If an employee wants to use any additional accrued
PDO during their leave, they should contact their supervisor and/or payroll representative. Any PDO used
will be counted against the employee’s available leave time for FMLA. After the employee has exhausted
their amount of accrued PDO, the remainder of their FMLA leave will be without pay.

An employee granted a leave to care for the employee’s child, spouse or parent with a serious health
condition would be allowed to use their Short Term Disability, in accordance with the STD policy, for the
period of time deemed medically necessary to care for the family member. An employee must exhaust all
STD before being removed from the payroll, when on a full leave of absence. Paid Time Off may be
utilized if the employee wishes to remain on the payroll after STD has been exhausted.

An employee who requests a leave of absence for his/her own serious health condition, which makes
him/her unable to perform his/her job, must use all
STD before being removed from the payroll, when on a full leave of absence. Before an employee on this
type leave of absence may return to work and/or be returned to the payroll, the employee must submit a
physician's statement to the immediate supervisor, with a copy to the Human Resources Department,
indicating that he/she is capable of resuming regular duties or the capacity in which the employee may
return with restrictions defined.

A mother granted leave to care for a newborn will be allowed to use the first six (6) weeks of leave time
from STD for a normal delivery or the first eight (8) weeks of leave time from STD for a cesarean delivery.
Any additional time beyond the recovery period will be deducted from the employee’s Paid Time Off
balance before being removed from the payroll.

A father granted leave to care for a newborn will be required to use Paid Time Off for the duration of the
leave since they are not under the care of a physician.

In cases where the employee is released to return to work by a physician’s work release and approved by
Unum, STD benefits will be paid only for the actual time approved by the physician. Employees released
with work restrictions of reduced hours that will allow the employee to transition back into the workplace
or employees who have scheduled absences approved for continuous FMLA will constitute eligibility of
payment of STD benefit in conjunction with regular worked wages, until released to full duty/normal
schedule.

Employees who are released with restrictions of reduced hours to transition back to work or have scheduled
continuous absences approved for FMLA are not required to satisfy their elimination period for each day
not working.

F. TREATMENT OF EMPLOYEE BENEFITS WHILE ON LEAVE
An employee on a leave of absence will remain eligible for, and will participate in, all applicable benefits
coverage(s) provided that the employee pays appropriate premium payments to the Human Resources
Department. Failure to pay the required premiums will result in termination of coverage(s). If the leave of
absence is medically necessary, the employee is responsible for his/her regular premium contribution while
on a leave of absence without pay. An employee on a leave of absence must contact the Human Resources
Department regarding his/her benefits premium payments.

G. REINSTATEMENT

Upon return from an FMLA leave, and assuming the employee satisfies such other requirements set forth in
this Policy, employees will be restored to the same or an “equivalent position” (as specifically described in
the FMLA) as held before the leave began. UHA may deny job restoration to certain “key employees’ if
necessary to prevent “substantial and grievous economic injury” (as specifically described in the FMLA
Regulations).

PROCEDURES

A. PROVIDING NOTICE OF FMLA LEAVE

             1.   Time Frame. Employees must give at least thirty (30) days advance notice of a qualifying
                  leave when practicable; otherwise, notice should be given as soon as it is practicable.

             2.   Contact Persons for Notice. Employees must call Unum at 866-245-2579 to report
                  Family Medical Leave and Disability claims. In addition, so that proper coverage can be
                  arranged, the employee must notify their supervisor (or follow the employee’s current
                  departmental call-off procedures).

             3.   Intermittent Leave Requirements. If intermittent leave time is certified by the employee’s
                  health care provider, the employee must notify Unum and the employee’s supervisor each
                  time the employee needs to take intermittent leave for a certified reason. Notice must be
                  given as soon as possible when using intermittent leave. Notice to Unum must be given
                  by midnight of the calendar day following the day the employee was first scheduled to
                  work. Note: UHA policy does not allow intermittent leave or a reduced schedule leave
                  for the birth, adoption or placement of a foster child.

             4.   Procedure Following Employee Notice.

                         a.   Unum will determine eligibility for Family Medical Leave based on
                              information provided by the employee and by UHA.

                         b.   Unum will send the employee a letter advising of eligibility, conditions of
                              leave and employee obligations during the leave period.

                         c.   Unum will process certifications/documentations and recertification’s for
                              Family Medical Leave and will advise employee of any incomplete or
                              insufficient certifications or documentations received, and provide appropriate
                              time frames for the return of all requested information.

B. DOCUMENTATION REQUIREMENTS

             1.    Medical Certification

                         a.   A Medical Certification (called a “Certification of Health Care Provider”
                              form) must be completed by a Health Care Provider and sent to Unum for
                              eligible employees who request Family Medical Leave for a serious health
            condition. The medical certification must contain sufficient facts to support
            the need for leave. If the employee is the patient, the information must be
            sufficient to establish that the employee cannot perform the essential functions
            of the employee’s job, the nature of any other work restrictions and the likely
            duration of such inability.

       b.   Failure to submit a complete and sufficient certification will result in a denial
            of FMLA leave until such time as a complete and sufficient certification is
            provided. A second or third medical opinion can be obtained at UHA’s
            expense and as allowed by law, if UHA has reason to doubt the validity of the
            medical certification.

       c.   The medical certification must be received within the period of time as noted
            in the request from Unum, unless not practicable, despite the employee’s
            diligent, good faith efforts.

       d.   In the case of Covered Service member Leave, the medical certification may
            be requested from the Department of Defense or Department of Veterans
            Affairs, and must be received within thirty (30) calendar days of when the
            leave is foreseeable. If the leave is not foreseeable, the medical certification
            should be produced within a reasonable period of time.

       e.   In the case of Bonding for Birth/Adoption/Foster Care of a child.
            A leave request that is for birth or adoption of a child or placement of a foster
            child will require documentation to support the request. Such documentation
            may include a hospital record, court document, or other official verification of
            the event for which the employee is requesting leave. The documentation must
            be received within fifteen (15) calendar days of when the leave is requested or
            5 calendar days after the event, whichever is greater. If the employee is
            requesting leave prior to the actual adoption or placement, separate
            documentation will be due within fifteen (15) calendar days or 5 calendar
            days, whichever is greater, of each absence.

       f.   UHA expects that employees will maintain contact with Unum appropriate
            representatives of UHA and their department manager while on leave and
            notify such persons of any changes in leave and their intent to return to work.

      g.    If the employee’s absence from work was due to the
            employee’s own illness, and the employee missed more than four (4) days of
            work, the employee must contact Unum and also obtain a release from a
            physician in order to return to work. .

      h.    The Medical Work Prescription Form must contain information sufficient to
            establish that the employee can perform the essential functions of their jobs,
            or document specific work restrictions and the duration of such inability.

            If the employee’s physician places any restrictions and/or
            limitations on the employee, the employee’s department
            manager and Employee Health will work with the employee to
            determine if the accommodations can be met.

2.   Recertification. UHA can require an employee to provide recertification at
     reasonable intervals as follows:

       a.   If the HCP provides a specific end date or duration for the need for leave,
            recertification will be requested no more often than every 30 days but no less
                               often than every six months; when the specific end date has passed, or the
                               employee requests an extension of a leave, the circumstances have changed
                               significantly, or the employer receives information that casts doubt upon the
                               employee’s stated reason for the absence.
                          b.   If the HCP does not provide a specific end date or duration for the need for
                               leave, a recertification will be requested every 30 days from the date of
                               signature on the medical certification unless: the employee requests an
                               extension of leave, the circumstances for the leave change significantly (e.g.,
                               the duration or frequency of the absences, the severity of the condition,
                               complications), or UHA receives information that casts doubt on the
                               continuing validity of the certification.

DEFINITIONS

1. “Serious health condition” is an illness, impairment, physical or mental condition that
    results in:

    a.    any period of incapacity or treatment related to inpatient care in a hospital, hospice or residential
          care facility;

    b.    any period of incapacity for more than 3 consecutive calendar days and any subsequent treatment
          or period of incapacity for the same serious health condition that also involved two or more visits
          to a health care provider within 30 days of the first day of incapacitation, absent any extenuating
          circumstances. The first of these visits must take place within seven (7) days of the first day of
          incapacity.

     c.    any period of incapacity for more than 3 consecutive calendar days and any subsequent treatment
           or period of incapacity for the same serious health condition that also involved one visit to a HCP
           followed by a supervised and continuing regimen of treatment;

     d.    pregnancy or prenatal care;

     e.    any period of incapacity or treatment for a chronic condition that requires treatment by a health
           care provider at least twice a year, continues over an extended period of time and may cause
           episodic rather than a continuing period of incapacity (e.g. asthma, diabetes);

     f.    a period of permanent or long-term incapacity that requires continual supervision by a HCP even
           though there may not be an active treatment (e.g., Alzheimer’s, terminal illnesses); or

     g.    any period of absence to receive or recover from treatments by a HCP for restorative surgery
           after an accident or injury, or for a condition likely to result in incapacity of more than 3
           consecutive days in the absence of treatment (e.g., chemotherapy, kidney dialysis).

    2. “Covered Service member Leave”: Leave for eligible employees to care for family
        members of "covered servicemembers" (meaning a spouse, son, daughter, or parent, or other next
        of kin) with a serious illness or injury incurred in the line of duty while on active duty. In order for
        the employee be eligible to take covered servicemember leave, the covered servicemember
        needing care must be either: (1) undergoing medical treatment, recuperation, or therapy; (2) in
        outpatient status; or (3) on the temporary disability retired list; or (4) is a veteran who is
        undergoing treatment for injury or illness that occurred any time during five years preceding the
        date of treatment.

    3. “Active Duty Leave”: Leave for eligible employees with a “covered military
        member” serving in the National Guard, Reserves, or are active duty Service Members, for
        activities arising from a covered military member’s active duty or call to active duty status to
        service in a foreign country, including the following: (1) short-notice deployment; (2) military
        events and related activities; (3) childcare and school activities; (4) financial and legal
        arrangements; (5) counseling; (6) rest and recuperation; (7) post-deployment activities and (8) any
        additional activities agreed to by the UHA and employee that are not included within the above
        listing. A “covered military member” is defined as an employee’s spouse, son, daughter, or parent
        on active duty or called to active duty status.




Judie F. Charlton, M.D.
Chief Medical Officer

								
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