Archdiocese Of Los Angeles Family And Medical Leave Forms Page 5


based on the list of essential job duties. You must present the doctor’s full release
confirming your fitness for duty and ability to perform the essential job functions before
you can return to work.
While on family and medical leave, an employee's group insurance coverage will continue at the
employee’s regular premium cost for a period of four months (16 weeks).
Pregnancy Disability Leave and Family Care Leave: An employee is eligible for up to 18 weeks
of benefits coverage for pregnancy related disability and up to 12 additional weeks of benefits
coverage during Family Care Leave to bond with their child.
Military Caregiver Leave: An employee is eligible for up to 26 weeks benefits coverage while
taking Military Caregiver Leave to care for a covered servicemember. Leave maximum is 26
weeks during a single 12 month period.
The employee is responsible for making these premium payments to the appropriate
administrator, i.e., Pastor, Principal, or the Insurance Department (for ACC/Cemeteries
According to the Consolidated Omnibus Reconciliation Act (COBRA) if the employee is still
disabled or does not return to work after four months, he or she may continue their medical
insurance for 18 months, but is responsible for the cost of the entire premium plus an
administrative fee. Mail premium payments directly to the health insurance administrators.
Should an employee fail to return after the end of the leave for a reason other than the
continuation, recurrence or onset of a serious health condition which would entitle them to
FMLA leave or other circumstances beyond their control, the employee may be liable for unpaid
portions of insurance premiums.
FMLA Leave is unpaid, but employees may use any accrued vacation or sick time, where
applicable, during leave. This paid time off will be counted against your FMLA leave
Employees who have elected voluntary disability insurance coverage, may choose to apply for
their disability benefit if they are taking a leave of absence for their own illness. Employees
receiving disability payments cannot simultaneously receive sick or vacation pay.


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