Leave of Absence
Frequently Asked Questions
Requesting a Leave of Absence
When Should I Request A Leave of Absence?
Contact FMLASource if you are absent from work, or know you will be absent from work, for more than three (3)
consecutive days due to the following:
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Your own serious health condition (including pregnancy)
To care for your newborn child
The placement of your adopted or foster child
To provide care for a qualifying family member with a serious health condition
To care for a covered service member injured in the line of duty
For qualifying military exigency, allowing family members to take leave to prepare for or deal with issues
that arise as a result of a family member being called to serve in the military
Uniformed Services Employment and Reemployment Rights Act (USERRA)
Helpful Hints: If you are pregnant and filing a leave, please request a leave for pregnancy disability. Bonding time
to care for your newborn will be set up when you have recovered from your pregnancy disability (typically 6 weeks
following your delivery).
How Do I Request a Leave of Absence from FMLASource?
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Call 1-888-243-5137; or
Online at www.fmlasource.com
FMLASource will confirm what type of leave you are eligible for and what form(s) are required. You will have 15
days to return the forms to FMLASource.
If you are incapacitated and unable to file your claim, a family member, your Manager or HR Leaves may initiate
the claim for you.
What leaves are administered through FMLASource? What leaves are
administered through HR/Benefits?
FMLASource administers the following leaves:
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Family and Medical Leave (FMLA)
Washington Family Leave Act (WFLA)
Washington Pregnancy Disability Leave (PDL)
Oregon Family Leave (OFLA)
First Year Family and Medical Leave
Personal Leaves
Washington and Oregon Domestic Violence Leave
HR/Benefits administers the following leaves:Americans with Disabilities Act (ADA)
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Military Leaves
Washington Military Family Leave
Bereavement Leave
027171 (07-2014)
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Jury/Witness Duty Leave
What happens after I apply for a leave through FMLASource?
FMLASource reviews all leave requests and supporting documentation, approves or denies leaves (with
the exception of Personal Leaves, which are approved by your Manager and the next higher Manager;
however, FMLASource will administer Personal Leaves). FMLASource also provides status updates to
Managers and HR Leaves throughout the process, including pending, approved, denied and expected
return from leave notifications.
FMLASource will notify you, your Manager and HR Leaves within 48 hours of your pending leave request
along with your rights and responsibilities and may request supporting documentation that must be
received within 15 calendar days.
Once sufficient documentation is provided to FMLASource, you, your Manager and HR Leaves will
receive an approval letter. If documentation is not received by FMLASource within 15 days, your leave
will be denied and you will need to request an appeal for additional time to submit documentation.
Unapproved leaves may result in disciplinary action, up to and including termination.
Do I apply for a leave of absence through FMLASource for workplace
accidents/illnesses if I am receiving compensation from Worker’s Comp?
Yes, you must apply for a leave of absence through FMLASource if you miss more than three (3)
consecutive days of work due to a workplace accident or illness. You will need to complete an Incident
Report and return to Facilities and file a Worker’s Compensation Claim at the doctor’s office or health
facility/hospital.
If you are out of the office for less than three (3) consecutive days, or have a reduced work schedule, you
must email HR Leaves with all time not worked due to your workplace accident or illness.
Does FMLASource share my medical information with my Manager?
No. All medical documentation provided directly to FMLASource is strictly confidential and maintained
solely by FMLASource. No medical information, other than the duration and frequency of absences, is
shared with your Manager. We encourage you to refrain from sharing medical information with other
associates, including your Manager.
Who is responsible for notifying Premera of my absence?
It is your responsibility to follow the normal absence reporting procedures and notify your Manager of your
absence.
Intermittent & Reduced Schedule Absences: You are required to report each intermittent absence to
FMLASource each week by Friday, in addition to following the normal absence call in procedures for your
Department. You are responsible for ensuring your absence is entered in eTime using the correct codes.
If you are an exempt associate, you must record ALL time off related to your intermittent leave, even if it’s
less than a full day (this is an exception to regular exempt rules for timekeeping).
Continuous Leaves: Until your continuous leave is approved, you are required to follow normal call in
procedures for your absences every day. Once your leave is approved, you are only required to call
FMLASource if there are changes to the approved start and/or end dates of your leave. Payroll will ensure
your time is allocated correctly in eTime when you are on a continuous leave.
What are FMLASource's customer services hours?
FMLASource’s customer service hours are 7:30 a.m. (CST) to 9:30 p.m. (CST). If you call outside these
hours, please leave a detailed voicemail message - including your name, phone number and employer and a customer service representative will return your call within 24-48 hours.
When I call to request my leave of absence, what questions will I be
asked?
You will be asked to provide the following information - in addition to other questions about your request
for leave:
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Employer Name: Premera
Employee ID Number or Social Security Number
Type of leave (continuous, intermittent, reduced work schedule)
Kind of leave (maternity, own serious health condition, etc.)
Date range for leave (start and end dates)
Healthcare provider contact information (name, phone and fax numbers)
When will I receive notification after I initiate a leave or claim?
After initiating a request for time off under FMLA or First Year Family and Medical Leave, FMLASource
will send you a letter confirming receipt of your leave request. If you called to request a leave, you will
receive an appropriate Certification Form (also provided below). These forms should be returned to
FMLASource by the due date indicated on your letter (typically 15 calendar days).
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Certification Form - Employee's Own Serious Health Condition
Certification Form - Family Member's Own Serious Health Condition
Certification Form – New Child
Where do I send the completed certification forms?
If you are required to submit paperwork, please have your healthcare provider send the completed forms
to:
FMLASource
Fax: 1-877-309-0218
Mail: 455 N. Cityfront Plaza Drive
Chicago, IL 60611-5322
Preference for submittal is fax.
What types of pay are available to me while on a leave of absence?
You may have the following replacement pay options available to you while on a leave of absence:
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Paid Time Off (PTO) - On any approved leave, Premera requires that you use all accrued
PTO before you may take unpaid leave (both continuous and intermittent leaves), unless
otherwise stated in the Leave of Absence Policy. However, if you have an approved Short Term
Disability (STD) claim and have satisfied your 14-day waiting period, you will not be paid PTO
during the time you are being paid by the disability carrier. Also, if you are on a reduced schedule
leave and are being paid by the disability carrier for the time you are not working, you will not be
paid PTO.
Note: FMLASource does not track the use or availability of PTO. Please contact Payroll for questions
regarding PTO balance and/or usage during leave.
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Extended Illness Balance (EIB) - On any approved leave, Premera requires that you use
all accrued EIB (if applicable) before you may take unpaid leave (continuous, reduced schedule,
and intermittent leaves), unless otherwise stated in the Leave of Absence Policy. To access EIB,
the associate must use PTO for the first 24 consecutive hours of absence per occurrence of
absence, unless the associate is on an approved intermittent or reduced schedule LOA. If the
associate is on an approved Intermittent or reduced schedule LOA, and wishes to use EIB
related to the Serious Health Condition for which the associate is taking LOA, the associate must
satisfy the 24 hour requirement only once during the leave year. After the 24 hour requirement
has been met for the leave year, the associate may use EIB for absences related to the certified
Serious Health Condition. No accruals will be added to the Extended Illness Bank.
However, if you have an approved Short Term Disability (STD) claim and have satisfied your 14-day
waiting period, you will not be paid EIB during the time you are being paid by the disability carrier.
To utilize EIB, the leave must be for your own serious health condition, or to care for a family member with
a serious health condition. EIB cannot be used for baby bonding. Please refer to the Paid Time Off
(PTO) Policy for detailed information.
Note: FMLASource does not track the use or availability of EIB. Please contact Payroll for questions
regarding EIB balance and/or usage during leave.
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United Way Days – You can choose, but are not required, to use United Way Days while on
leave.
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Premera Days – You can choose, but are not required, to use Premera Days while on leave.
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Holiday Pay - Associates are eligible to receive holiday pay if they are receiving pay (regular,
PTO, EIB, Premera Days or United Way days) the business day before and the business day
after the holiday.
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Short-Term Disability (STD) - If approved by the carrier, STD provides 60% or 66 2/3% of
salary up to $1,500/week. There is a 14 calendar day elimination or waiting period for benefits to
begin. STD is typically used for Maternity Leaves and for an employee’s own serious health
condition. Although you may be eligible for other replacement pay options, we suggest you
initiate an STD claim. Disability benefits coordinate with your other pay options, and may be
available in the event your health condition extends beyond your allowable replacement pay.
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Long-Term Disability (LTD) - If approved by the carrier, LTD provides 60% or 66 2/3% of
salary up to $15,000/month. There is a 90 day elimination or waiting period for benefits to begin.
Please note: some associates may qualify for a higher monthly benefit amount – please contact
HR Leaves if you have questions.
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Worker’s Compensation - If you miss work due to a workplace accident, injury or illness
and your doctor certifies you are unable to work, L&I may pay for a portion of your lost wages,
called "time-loss compensation." However, the 3 days in a row of work immediately following
your injury are considered a waiting period. L&I won't pay for these days, if they are the only
ones you miss. Time-loss compensation benefits can replace some — but not all — of the
wages you were earning. The benefit amount is typically 60 to 75% of the wage you were
earning (up to a limit), depending on how many dependents you have.
How do I file a Short Term Disability (STD) claim?
STD benefits are provided when you are on leave for your own illness or injury when disabled for greater
than 14 days. You must apply separately from the leave application process with FMLASource. Our
disability carrier is USAble.
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Print a copy of the Short Term Disability (STD) Claim Form
Complete the application and send both the Employee Statement and the Attending Physicians
Statement to USAble either by fax (501-235-8417) or by email to claims@usablelife.com
HR Leaves will complete the Employer Statement and provide to USAble once notification of
your leave request is received from FMLASource
Once USAble has received the complete STD application form, you will receive written acknowledgement
with contact information for any questions you may have about your benefits along with the claim status.
How long does it normally take for an STD claim decision?
It will take approximately 5-7 business days to make a claim decision (once your completed claim
application is received). If USAble has not made a decision within one week, you will be notified as to
why.
How do I request a Personal Leave?
You will need to request a Personal Leave through FMLASource who will request pre-approval with your
Manager prior to sending you the Personal Leave Request Form. The request form must be signed by
yourself, your Manager, and your Manager’s Manager and returned to FMLASource for processing.
How do I request additional leave time for Maternity or Paternity Leaves?
If you are requesting more leave than what is provided by law, you will need to request a Personal Leave.
Please see procedures stated above on how to apply for a Personal Leave.
Can I take intermittent leave for baby bonding under FMLA or First Year
Family and Medical Leave?
Baby bonding can be taken on a continuous basis in no more than two increments. If you need or would
like to take time off in smaller increments whether short term or on a long term basis, please request an
alternative work schedule with your Manager. More information can be found on the Alternative Work
Schedule Policy.
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While On a Leave of Absence
Do I accrue PTO while on leave?
You will continue to accrue PTO when paid on Premera Payroll with PTO and/or EIB until exhausted; after which
your status will be unpaid and then you will no longer accrue PTO.
Associates on intermittent leave continue to accrue PTO each pay period.
How will my benefits be affected while on leave? How will I pay back my portion
of premiums?
Premera will maintain its contributions to your health insurance premiums while you are on leave (with the
exception of Personal Leaves; please refer to the Leave of Absence Policy). If you do not return from leave, you
will be responsible for reimbursing Premera for any premiums paid during the leave period.
Some of your benefit deductions may not be paid while you are on leave if you are not receiving a paycheck
requiring you to pay back the missed deductions after you return from leave. Therefore, your normal benefit
deductions plus an additional deduction will be taken for each benefit missed until your premium deductions are
caught up.
How do I add my newborn or newly adopted child to my benefits?
You must add your newborn or newly adopted child to your healthcare coverage within 31 days from the date of
birth or date of placement/adoption. If elections are not made within that time you must wait until the next Open
Enrollment Period to add coverage. Please email Benefitsinfoline@premera.org or call 425-918-5964 to add
your new child to benefits.
How do I report intermittent leave time?
You must contact FMLASource to report any absence related to your certified intermittent leave each week by
Friday, in addition to following the normal absence call in procedures with your Department each day that you will
be absent. If you are approved for intermittent leave and have a pre-scheduled block of time that you will miss (for
example, you are caring for a family member and will be with them for a week as part of that care), you can advise
FMLASource at the beginning of that block of time. This must be scheduled in advance with your Manager.
The following eTime codes should be used for approved intermittent leaves:
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LOA PTO – use for PTO related to your leave.
LOA EIB – use once you have used 24 hours of PTO related to your leave.
LOA Time Not Worked (Non-exempt associates only) – use to record time related to your leave
when PTO and EIB is no longer available.
LOA Timeloss (Exempt associates only) – use to record time related to your leave when PTO and
EIB are not available; this will offset regular hours.
Optional Coding: use LOA United Way Day and/or LOA Premera Days for absences related to a leave of
absence
Only time used related to the certified condition is covered under job-protected leave. Absences for any other
reason, even if they occur on the same day are covered under Premera’s Paid Time Off (PTO) and Attendance
Policies.
Exempt associates must report and record any absence related to FMLA or First Year Family and Medical Leave,
even if it is a partial day’s absence. If an exempt associate uses FMLA or First Year Family and Medical Leave for
part of the day, and takes time off for other reasons for the remainder of the day, they must use LOA PTO codes
for the remainder of that day (note: even partial days missed must be reported to FMLASource).
How do I report reduced schedule leave time?
A reduced schedule leave is an approved leave with a specific schedule that is fewer work hours then the
associates’ regular schedule. For example, you regularly work 8 hours per day, 5 days per week and have a
reduced schedule leave approved for 4 hours per day, 5 days per week.
When you work the approved reduced schedule hours, you do not need to contact FMLASource each day. If the
predictable schedule of hours changes, you must contact FMLASource, as well as following the normal absence
call-in procedures for your department.
Reporting in eTime – it’s very important to remember that a reduced-schedule leave is not the same thing as a
part-time position. You must record any time not worked using the codes listed above. For example, if you
normally work 5 days per peri, 8 hours per day, and are approved for a reduced-schedule of 5 – 6 hour days per
week, you must record 2 hours of time using the codes listed above each day.
How do I report continuous leave time?
Once a continuous leave is approved, FMLASource will record leave time used in accordance with the expected
start and return date for the leave. You are not required to call FMLASource unless your expected start and/or
return date changes. If your expected return date does change you should also contact your Manager and HR
Leaves to notify them of that change.
When your leave is approved on continuous leave, HR Leaves will input that status into PremeraConnect. As soon
as that status is updated in the system, Payroll will be responsible for reporting time used in eTime, and you will no
longer appear on the Manager’s list in eTime. Managers should monitor eTime at the start of any leave to ensure
the associate is not showing on their list of active associates and should contact HR Leaves if an associate on
approved continuous leave continues to appear in eTime.
How do I report time when a leave has been requested, but is not yet approved?
When feasible, you should provide 30 days prior notice when your leave is foreseeable, and, provide notice as
soon as practicable in cases where the leave is not anticipated.
However, there are occasions when you may be absent before the leave request has been approved. In those
cases, you will not have access to the LOA codes in eTime (these codes become available once the leave is
processed by HR Leaves). Time should be recorded in eTime in accordance with Premera’s Time Reporting
policy, but the comment “Pending LOA” should be added to each timestamp related to the leave. Reporting time
used to FMLASource must follow the procedures above (intermittent leave should be reported to FMLASource).
How to I report an absence online with FMLASource?
You can report your intermittent absences online with FMLASource at www.FMLASource.com. This feature is
available to you when you have an approved leave of absence claim or one that is pending approval. You will still
be able to call FMLASource at 1-888-243-5137 to report time missed; this feature simply provides an additional
means of reporting.
Note: you still also need to follow normal business call-in procedures when taking leave
time. To report time you should log on to your account and select the ‘report time’ link for the appropriate
corresponding intermittent leave. Then enter the date, hours, and minutes for any time used. Any prior hours used
and not recorded for your leave must be reported directly to FMLASource.
Will I have network and security access while on leave? What should I do with my laptop?
While on continuous leave, it is Premera's practice to disable network and security access so that we do not
interfere with your leave and subsequently deny you the time away in which you are entitled. You will be removed
from Outlook directory; however, you will still continue to receive incoming emails and your out of office message
will function as normal. Also, your laptop should be left on Premera premises.
Why is my network and security access deactivated while on leave?
While on continuous leave, it is Premera's practice to disable network and security access so that we do not
interfere with your leave and subsequently deny you the time away in which you are entitled. You will be removed
from Outlook directory; however, you will still continue to receive incoming emails and you out of office message
will function as normal. Also, your laptop should be left on Premera premises.
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Returning From a Leave of Absence
What needs to be done BEFORE I return to work? How do I get network and
security access reactivated?
FMLASource will send you a Return to Work notification as well as Return from Leave Forms two weeks prior to
your scheduled return date informing you of your responsibilities prior to returning to work. You must notify
FMLASource of any changes to your return date, as well as submit supporting documentation, if required.
It's important to follow the return from leave process so that your transition back to work is as smooth as possible.
Otherwise, there will be a delay in reinstating your computer and system access including email and eTime.
Please take the following steps:
Step 1: If you were on leave for your own serious health condition, have your healthcare provider complete the
Medical Return to Work Release Form and fax or email it to FMLASource at least 3 business days prior to your
scheduled return to work date. If restrictions are listed, you must contact your Manager to determine whether or
not Premera can accommodate your restrictions.
Step 2: If you are on leave for any other reason, complete the Premera Return From Leave Form and fax or
email to FMLASource at least 3 business days prior to your scheduled return to work date.
NOTE: If you fail to submit the required form(s), you will not have access to your computer or be allowed to work
until the forms have been received.
If your situation changes and you will be returning to work earlier than your scheduled date, notify FMLASource,
your Manager and HR Leaves as soon as possible and return all the forms described above so that they are
received at least 3 business days prior to your new return date.
Also approximately two weeks prior to your scheduled return to work date, your Manager may contact you to
ensure that you have everything needed to smoothly return to work and to answer any questions you may have.
I want to return to work on a part-time or reduced work schedule upon return
from Maternity or Paternity Leave. What should I do?
If you would like to return from leave part-time or on a reduced work schedule, you can request an alternative work
schedule with your Manager. More information can be found on the Alternative Work Schedule Policy.
What Other Resources Are Available To Me?
FamilySource® is a free benefit available to you and your family provided by the work-life experts at
GuidanceResources®, your employee assistance program. This service helps you with the challenges of trying to
balance the many demands of your work and life.
When you call GuidanceResources with a concern about a life or family issue, a Guidance Consultant will talk to
you about your specific situation and connect you to a Resource Specialist who will begin to research alternative
solutions to your question. Within a few business days you’ll have a full report of practical information and
affordable alternatives that can be delivered to you via email, fax or second day air.
Call GuidanceResources at 877-637-8327 for more information or Online at www.guidanceresources.com;
company code: PRE2255
Who do I contact if I have questions about FMLASource, USAble or if I am
experiencing service issues?
If you have any questions about FMLASource, USAble or are having service issues please contact HR Leaves for
assistance.