Form Fmla-Hr2a - Notice Of Eligibility And Rights And Responsibilities - State Of Connecticut Human Resources Page 5

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If your leave does qualify as federal or state family/medical leave or military family leave,
you will have the following rights while on leave:
You have a right under the federal FMLA for up to 12 workweeks of leave (unpaid or paid using accruals) in a
12-month period which is calculated as the 12-month period measured forward from the date of your first
federal FMLA leave usage.
You have a right under the federal FMLA for up to 26 workweeks of leave (unpaid or paid using accruals) in a
single 12-month period to care for a covered servicemember or a covered veteran with a serious injury or illness.
This single 12-month period commences on the first day that you take leave for this purpose.
You have a right under the state FMLA for up to 16 workweeks of leave (unpaid or paid using accruals) in a 24-
month period which is calculated as the 24-month period measured forward from the date of your first state
FMLA leave usage.
You have a right under the state FMLA for up to 26 workweeks of leave (unpaid or paid using accruals) in a
single 24-month period to care for a covered servicemember or a covered veteran with a serious injury or illness.
This single 24-month period commences on the first day that you take leave for this purpose.
Your health benefits must be maintained during any period of unpaid federal or state family/medical leave under
the same conditions as if you continued to work.
You must be reinstated to the same or an equivalent job with the same pay, benefits, and terms and conditions of
employment on your return from federal or state family/medical leave. If your leave extends beyond the end of
your federal FMLA leave entitlements, you do not have return rights under federal FMLA. If you leave extends
beyond the end of your state FMLA leave entitlements, you do not have return rights under state FMLA.
If you do not return to work following federal or state family/medical leave for a reason other than: 1) the
continuation, recurrence, or onset of a serious health condition which would entitle you to leave; 2) the
continuation, recurrence, or onset of a covered servicemember’s serious injury or illness which would entitle you
to leave; or 3) other circumstances beyond your control, you may be required to reimburse the State for the
employer’s share of health insurance premiums paid on your behalf during your family/medical leave.
You have the right to have vacation, personal leave or compensatory leave run concurrently with your federal or
state family/medical leave entitlement, provided you meet any applicable requirements of the leave policies. If
you do not meet the requirements for taking paid leave, you remain entitled to take unpaid federal or state
family/medical leave.
(Form: FMLA-HR2b)
This form provided by the Department of Administrative Services

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