Who Pays Health Insurance Premiums During FMLA Leave?

During FMLA leave, your employer keeps paying its share of your health insurance premiums and you keep paying yours, on the same terms as if you were still at work. Federal law requires the employer to maintain your group health plan coverage for the duration of leave, which means neither side’s cost split changes just because you’ve stepped away.¹ The real question most people are asking is how you get your portion to the employer when paychecks stop, and what happens if a payment slips.

The Employer’s Share Does Not Change

A covered employer must maintain your group health coverage at the same level and under the same conditions as if you had kept working.² If you had family coverage before leave, the employer can’t shift you to individual coverage. Dental, vision, and mental health benefits attached to the plan stay in place too.

The employer’s contribution percentage doesn’t move. If it was covering 80 percent of the premium before leave, it covers 80 percent during leave. You can’t be charged more for coverage than you would pay at your desk, and the employer can’t tack on any administrative fee for handling your payments during leave.³

Protection lasts through the FMLA leave period itself: up to 12 weeks a year for most qualifying reasons, up to 26 weeks for military caregiver leave.⁴

How You Actually Pay Your Share

The mechanics depend on whether you’re still getting a paycheck.

While You’re Using Paid Leave

If you’re substituting accrued vacation, sick time, or other paid leave, your premiums come out of your paycheck the same way they always did.³ Nothing changes from a billing standpoint, which is one reason many employees burn through paid leave first.

Once Leave Is Unpaid

When paid leave runs out, or if your leave is unpaid from the start, you and your employer need another arrangement. Federal regulations give the employer several options for collecting your share:

Pay-as-you-go on the same schedule as your old payroll deductions, usually biweekly or monthly.
The same timetable that would apply under COBRA continuation coverage.
Prepayment before leave begins, sometimes through larger payroll deductions in the weeks leading up to your leave.
Catch-up on return, where the employer fronts your share and you repay it when you come back, either as a lump sum or through adjusted deductions.

Your employer has to give you written notice before leave begins spelling out which method applies and what the terms are.⁵ Read it carefully. The payment method controls when a payment is considered late, and late payments can cost you coverage.

If a Payment Is Late

Your employer’s obligation to maintain coverage can end if a premium payment is more than 30 days past due. Before dropping you, though, the employer must mail a written notice at least 15 days before the coverage termination date, telling you the payment hasn’t arrived and stating the exact date coverage will end if it doesn’t.⁶

So you have roughly a 45-day window from the due date: 30 days of grace plus 15 days of advance notice. If your employer already gives a longer grace period to employees on other unpaid leave, that longer period applies here too.

Losing coverage for nonpayment doesn’t cost you your other FMLA rights. You still return to the same or an equivalent job, and your employer must restore your health benefits at that point as if the lapse never happened.⁵

Coverage When You Come Back

When you return from FMLA leave, your employer must reinstate your health benefits immediately, whether or not coverage lapsed during leave. You go back to the same coverage level you had before, including any family or dependent coverage, with no new waiting periods, no physical exams, and no pre-existing condition exclusions.⁵

That protection applies even if you voluntarily dropped coverage during leave to save money. You can pick it right back up when you return.

When the Employer Can Get Its Money Back

If your employer paid its share of premiums to keep your coverage active during unpaid FMLA leave and you don’t come back, it can seek reimbursement of what it paid.⁷ Recovery is limited to the employer’s share, not yours, and only for periods of unpaid leave. If part of your leave was paid, or you were receiving workers’ compensation, premiums for those periods can’t be recovered.

Two exceptions block recovery even when you don’t return:

A serious health condition, including the continuation, recurrence, or onset of one affecting you or a covered family member, prevents your return.
Circumstances beyond your control keep you from coming back. Examples include being laid off during leave, a spouse’s unexpected job transfer of more than 75 miles, or needing to care for a seriously ill relative who isn’t a covered family member under the FMLA.

If you claim a serious health condition, the employer can require medical certification. You have 30 days to provide it, and you pay for it. Miss that deadline, or fall outside both exceptions, and the employer can recover 100 percent of the health premiums it paid during unpaid leave.⁷

To count as having returned, you need to work at least 30 calendar days after leave ends. Coming back for a week and quitting can be treated as a failure to return. An employee who goes directly from FMLA leave into retirement is considered to have returned.⁸

COBRA If You Don’t Come Back

Going on FMLA leave is not itself a COBRA qualifying event, so COBRA doesn’t start when leave starts.⁹ If you don’t return after FMLA leave expires and would lose coverage as a result, a qualifying event is triggered on the last day of your FMLA leave. The plan must then offer you and your dependents the option to elect COBRA continuation coverage.

One detail catches people. If your coverage lapsed mid-leave because you stopped paying, that lapse doesn’t reset the clock. The qualifying event still runs from the last day of your FMLA entitlement, and the maximum COBRA coverage period runs from that same date.⁹ Under COBRA, you pay the full premium (your old share plus what the employer used to contribute) plus up to a 2 percent administrative fee.

Non-Health Benefits Follow a Different Rule

The “employer keeps paying” rule is specific to group health coverage. Life insurance, disability insurance, retirement contributions, and accrued vacation are handled the way your employer handles those benefits for employees on other comparable forms of leave.² If the company continues life insurance during unpaid personal leave, it continues it during FMLA leave. If it doesn’t, it doesn’t. Whatever happens to those benefits during leave, they’re restored when you return.⁵

1
Office of the Law Revision Counsel. 29 USC 2614 – Employment and Benefits Protection
2
eCFR. 29 CFR 825.209 – Maintenance of Employee Benefits
3
eCFR. 29 CFR 825.210 – Employee Payment of Group Health Benefit Premiums
4
U.S. Department of Labor. Fact Sheet 28 – The Family and Medical Leave Act
5
U.S. Department of Labor. Fact Sheet 28A – Employee Protections Under the Family and Medical Leave Act
6
eCFR. 29 CFR 825.212 – Employee Failure to Pay Health Plan Premium Payments
7
eCFR. 29 CFR 825.213 – Employer Recovery of Benefit Costs
8
U.S. Department of Labor. Employer Recovery of Benefit Costs
9
eCFR. 26 CFR 54.4980B-10 – Interaction of FMLA and COBRA