Category: HR-BEN
POLICY & PROCEDURE
Subject:
Leave of Absence – Family and Medical
Classification:
Management Approved
Policy Owner:
Senior Vice President, Human Resources
Approved by:
WFH President and CEO
Effective: October 1, 2011
POLICY:
It is the policy of Wheaton Franciscan Healthcare (WFH) to provide eligible associates with a
leave of absence when an associate encounters circumstances that necessitate time off from
work due to personal and/or family medical needs for non-work related illnesses or injuries.
RATIONALE:
Our Value of Development calls us to recognize and respect the need for every associate to
maintain a balance between work life and personal life. The leave of absence policy
supports a balance between the associate’s needs and WFH's need to provide adequate
staffing. This policy also complies with federal and state laws.
SCOPE:
This policy applies to all WFH associates in the owned and managed regions.
PROCEDURE:
There are two (2) types of medical leaves:
1. Leaves covered by the federal Family Medical and Leave Act, (FMLA). Wisconsin
associates may also have additional rights under the Wisconsin Family and Medical
Leave Act (WFMLA) and pregnant associates in Iowa are covered by the Iowa Civil
Rights Act (IA Code).
2. General Medical Leave - Non FMLA.
I. Family/Medical Leave – FMLA/WFMLA/IA Code
Eligibility
All associates with 12 months of employment who have worked at least 1,250 hours during
the preceding 12 months are covered by the federal FMLA. For Wisconsin associates,
WFMLA eligibility requires employment for at least 52 consecutive weeks and at least 1,000
compensated hours during those 52 weeks. Iowa associates who are pregnant are eligible
for leave under IA Code upon hire.
Maximum Length of Leave
Associates are eligible for up to 12 weeks of unpaid FMLA leave during a rolling 12-month
period for the following reasons:
 Associate's own serious health condition;
 To care for a child after birth, placement for adoption or foster care within 12 months
after birth or placement (If both spouses work for WFH, their combined leave shall not
exceed 12 weeks);
 To care for a spouse, dependent child, or parent who has a serious health condition;
 A qualifying exigency arising out of the fact that the associate’s spouse, son, daughter or
parent is a covered military member on covered active duty (or has been notified of an
impending call or order to covered active duty) in the armed forces.
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Associates are eligible for up to 26 weeks of unpaid leave during a rolling 12-month period
for the following reasons:
 To care for a covered family member (spouse, son, daughter, parent or next of kin) who
has incurred an illness or injury in the line of duty while on active duty in the Armed
Forces provided that such injury or illness may render the family member medically unfit
to perform duties of the member’s office, grade, rank or rating.
 Leave to care for an injured or ill covered servicemember, when combined with other
FMLA-qualifying leave, may not exceed 26 weeks in a single 12-month period.
Wisconsin associates are also eligible for up to six (6) weeks of unpaid WFMLA leave during
a calendar year for the following reasons:
 Associate's own serious health condition (2 weeks);
 To care for a parent, child, spouse, domestic partner, domestic partner’s parent or
parent-in-law's serious health condition (2 weeks);
 To care for a child after birth/adoption of a child (6 weeks).
Iowa associates who are pregnant are eligible for leave as follows:
 Leave of absence for the period that the associate is disabled because of the associate’s
pregnancy, childbirth, or related medical conditions, or for eight (8) weeks, whichever is
less.
WFMLA and IA Code leaves run concurrently with FMLA leave. If an associate is receiving
short-term disability benefits for a FMLA, WFMLA, and/or IA Code reason, the associate’s
disability period will run concurrently with these leaves.
Definition: Serious Health Condition
A serious health condition is an illness, injury, impairment or physical or mental condition that
involves:
 incapacity or treatment in connection with inpatient care; or
 any period of incapacity of more than three (3) full consecutive calendar days plus (1)
one (1) treatment visit by a health care provider within seven (7) days of first day of
incapacity and at least one (1) additional treatment visit by a health care provider within
30 days of the first day of incapacity or (2) one (1) treatment by a health care provider
within seven (7) days of the first day of incapacity resulting in a regimen of continuing
treatment under supervision of a health care provider; or
 a chronic condition which (1) requires periodic visits for treatment by a health care
provider (at least two (2) times per year), (2) continues over an extended period of time,
and (3) may cause episodic rather than a continuing period of incapacity; or
 a period of incapacity which is permanent or long-term due to a condition for which
treatment by a health care provider may not be effective; or
 any period of absence to receive multiple treatments by a health care provider either for
restorative surgery after an injury or for a condition that would likely result in a period of
incapacity of more than 3 consecutive calendar days in the absence of medical
intervention or treatment; or
 any period of incapacity due to pregnancy, or for prenatal care.
Process for requesting FMLA and/or WFMLA or IA Code Leave
Associates requesting leave must provide their supervisor and HR Connect with 30 days
advance notice when the leave is foreseeable and make a reasonable effort to schedule the
treatment so as not to unduly disrupt WFH’s operations. If the leave is not foreseeable or if it
is requested for a qualifying exigency, the associate must give notice as soon as practicable.
It is the associate's responsibility to contact HR Connect within 20 days of the initial date of
disability or the leave of absence will be denied. The required documentation for a leave of
absence request is to be submitted no later than 22 days from the date of the request for the
leave. If the required documentation is not completed and returned, the leave of absence will
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be denied and may be considered unexcused and subject to our attendance policy
guidelines.
Required Documentation (additional documentation is required for Short Term Disability
benefits)
1. Qualifying Exigency Leave
 A Certification Form supporting leave for a qualifying exigency;
 A copy of the covered military member’s active duty orders.
2. Military Caregiver Leave
 Health Certification Form to be completed by an authorized health care provider
of the covered servicemember.
3. All Other Leaves
 A Health Certification Form to be completed by a health care provider.
 An updated Health Certification Form may be requested every 30 days.
4. Intermittent Leave
 Intermittent Leave Time Tracking Form to be completed and faxed by the
associate to HR Connect by the end of each pay period.
Intermittent Leave
Intermittent leave may be taken under the following circumstances:
1. FMLA: For birth, adoption, or foster care of a child, intermittent leave is subject to the
approval of WFH. For the serious health condition of the associate, spouse, child, parent,
covered servicemember, intermittent leave may be taken if it is medically necessary and
after making a reasonable attempt to schedule leave so as not to unduly disrupt WFH’s
operations, subject to the approval of the treating health care provider. For a qualifying
exigency, intermittent leave may be taken.
2. WFMLA: Associates requesting intermittent family leave should schedule all partial
absences so they do not unduly disrupt WFH’s operations. Associates intending to take
leave due to a planned medical treatment of a child, spouse, parent or associates who
intend to take medical leave because of their own planned medical treatment, must make
a reasonable effort to schedule the medical treatment so that it does not unduly disrupt
WFH’s operations, subject to the approval of the health care provider.
3. IA Code: Under the IA Code, pregnant associates requesting intermittent leave should
schedule all absences so they do not unduly disrupt WFH’s operations. Associates are
allowed to take intermittent medical leave if the leave is medically necessary and related
to the pregnancy.
4. Intermittent Leave may be taken in 15 minute increments up to the number of hours
scheduled to work.
Coordination with Workers Compensation
If an associate is receiving worker's compensation benefits for a FMLA qualifying reason, the
associate's worker's compensation period and FMLA leave will run concurrently. Please see
the Occupational Injury/Illness Policy for additional details regarding work related injuries.
Compensation and Benefits while on Leave
FMLA/WFMLA/IA Code leave is unpaid time. However, an associate may be eligible for pay
under the short and long term disability plans if his/her leave is for his/her own serious health
condition. An associate must contact the disability administrator to initiate a disability claim.
Refer to the Summary Plan Descriptions for more information on these benefits. While on an
approved FMLA/WFMLA/IA Code leave, Paid Time Off (PTO) will be paid as follows:
For the duration of a FMLA/WFMLA leave, the associate has the option to pay
himself/herself PTO up to his/her FTE. For IA Code leave which is not covered by FMLA, the
associate is required to use PTO to cover this unpaid leave. If Short Term Disability (STD) is
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paid during a FMLA/WFMLA/IA Code leave, the associate may only use PTO to supplement
the STD payments. For example, if the associate receives 40 hours of STD at a 60%
benefit, the maximum amount of PTO that can be paid is 16 hours (40 hours times 40%
which is 100% minus the 60% benefit). If the leave is unpaid, PTO may be used up to
his/her FTE.
An associate on a FMLA/WFMLA/IA Code leave continues to be covered by the group health
plan benefits under the same terms that existed before the leave began, provided the
associate makes any applicable monthly contributions on a timely basis.
Return from Leave
An associate must notify his/her supervisor, HR Connect and the disability administrator of
his/her return to work date as soon as the return to work date is known. A return to work
authorization form must be completed and turned into HR Connect before an associate may
return to work.
Upon return to work from FMLA/WFMLA/IA Code leave, the associate will be reinstated to
his/her former position, or if such position is not available, to an equivalent position for which
the associate is qualified, with equivalent benefits and conditions of employment. If the
associate fails to return to work by his/her scheduled return to work date, it may be
considered a voluntary resignation.
Authorization to Return to Work with Temporary Restrictions
If the associate's health care provider returns the associate to work with restrictions, the
restrictions will be reviewed by the disability administrator and the associate's supervisor to
determine if there is work available on a temporary basis that is within the associate's
restrictions. The maximum time that this work will be provided is six (6) months. The
disability administrator will notify the associate if this work is available.
Exhaustion of FMLA/WFMLA/IA Code Leave
An associate who has exhausted the FMLA/WFMLA/IA Code leave due to his/her own
serious health condition and is unable to return to work, may be placed on a General Medical
leave. An associate who has exhausted his/her FMLA/WFMLA due to a family member’s
serious health condition may apply for a Personal Leave of Absence.
II.General Medical Leave – (Non FMLA)
Eligibility
Associates who are not eligible for or have exhausted FMLA/WFMLA/IA Code leave are
eligible to apply for an unpaid General Medical leave for their own serious health condition.
Maximum Length of Leave
An associate with six (6) or more months of service may remain on a General Medical leave
for a maximum of six (6) months from the first date of disability. An associate with less than
six (6) months of service may remain on General Medical leave for a maximum of two (2)
months from the first date of disability. General Medical leave is to be used for a continuous
illness or injury lasting three (3) or more calendar days and may not be used intermittently. If
an associate exhausts his/her maximum amount of General Medical leave and is not
released to return to work, his/her employment will be terminated.
Process for requesting a General Medical leave:
An associate requesting a General Medical leave must provide his/her supervisor, HR
Connect and the disability administrator with 30 days advance notice when the leave is
foreseeable and make a reasonable effort to schedule the treatment so as not to unduly
disrupt WFH’s operations. If the leave is not foreseeable, the associate must give notice as
soon as practicable. It is the associate's responsibility to contact HR Connect and the
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disability administrator within 20 days of the initial date of disability or the leave of absence
will be denied. The required documentation to finalize a leave of absence request is to be
turned in no later than 22 days from the date of the request for the leave. If the required
documentation is not completed and returned, the leave of absence will be denied and may
be considered unexcused and subject to our attendance policy guidelines.
Required Documentation (additional documentation is required for Short Term Disability
benefits):
 A Health Certification Form to be completed by a health care provider.
 An updated Health Certification Form may be requested every 30 calendar days.
Coordination with Worker’s Compensation
If an associate is receiving worker’s compensation benefits for a General Medical leave, the
associate’s worker’s compensation period and General Medical leave will run concurrently.
Please see the Occupational Injury/Illness Policy for additional details regarding work related
injuries.
Compensation and Benefits while on Leave
General Medical leave is unpaid time. However, an associate may be eligible for pay under
the short term and/or long term disability plans. An associate must contact the disability
administrator to initiate a disability claim. Refer to the Summary Plan Descriptions for more
information on these benefits. An associate is required to use PTO to cover this unpaid
leave equal to his/her FTE. PTO must be used until the end of the leave or until PTO is
exhausted.
If short or long term disability benefits are paid during this medical leave, the associate must
use PTO to supplement the disability payments. For example, if the associate receives 40
hours of STD at a 60% benefit, the maximum amount of PTO that can be paid is 16 hours
(40 hours times 40% which is 100% minus the 60% benefit). If the associate is not eligible
for disability benefits, PTO must be used up to his/her FTE.
An associate on a General Medical leave continues to be covered by the group benefit plans
under the same terms that existed before the leave began, provided the associate makes
any applicable monthly contributions on a timely basis. When an associate exhausts the
maximum amount of leave under this policy, continuation coverage will be offered to eligible
associates, pursuant to COBRA.
Return from Leave
The associate does not have job protection rights while on General Medical leave. WFH
may at its discretion post, fill or eliminate the associate's position at any time based on the
staffing needs of the organization.
Prior to returning to work, the associate must notify his/her supervisor, HR Connect and the
disability administrator of his/her return to work date. A return to work authorization form
must be completed and submitted to HR Connect before an associate may return to work. If
the associate's position is open, the associate may return to work. If the associate's position
is no longer available, the associate may apply for any open positions that he/she is qualified
for within 30 days from his/her authorization to return to work. If the associate is not placed
into another position within the 30 days, his/her employment will be terminated. The
associate will be placed on a personal leave of absence during the 30 day period. If the
associate fails to return to work by his/her scheduled return to work date, it will be considered
a voluntary resignation.
Successive Periods of Medical Leave
One General Medical leave following another is counted as a single leave unless the
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associate returns to work and 1) has been released by his/her physician to return to work
with no restrictions and works at least one full day and a new medical leave is totally
unrelated to the original medical leave; or 2) the second medical leave is related to the
original medical leave but the associate returns to work for 14 consecutive days preceding
the commencement of the second medical leave.
Authorization to Return to Work with Temporary Restrictions
If the associate's health care provider returns the associate to work with restrictions, the
restrictions will be reviewed by the disability administrator and the associate's supervisor to
determine if there is work available on a temporary basis that is within the associate's
restrictions. The maximum time that this work will be provided is six (6) months. The
disability administrator or manager will notify the associate if this work is available. If the
associate fails to return to work by his/her scheduled return to work date, it will be considered
a voluntary resignation.
*If you are an associate covered by a collective bargaining agreement, please refer to the
CBA regarding maximum amount of leave time available.
Replaces:
WFH-Racine: Leave of Absence; WFH-Iowa: Family & Medical Leave (HR032); WFHMilwaukee: Leave of Absence (II.B.4.0); WFH-Illinois: Absence, Leave of (901-A)
Cross reference:
Leave of Absence-Education, Military and Personal
Paid Time Off (PTO)
Review Period:
One (1) year
Original Policy Date:
July 14, 2006
Dates Updated:
September 1, 2007; July 1, 2008; January 16, 2009; April 1, 2009; August 1, 2009;
January 1, 2010; October 1, 2011
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