Family Medical Leave Act (Fmla) And Oregon Family Leave Act (Ofla) Forms Packet, Form Cd 1422 - Employee Medical Status Report Page 10
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12b. Hardship donations can only be requested once all leave has been exhausted. If
you are banking leave time, you will not be eligible for hardship donations until the
leave is exhausted.
4. Core Benefits
a. Medical, Dental, Vision, and Basic Life Insurance are considered the core benefits
provided by the state. While under protected leave (FMLA/SAIF/Military) the state
will continue to pay its portion toward premium payments. You may also be eligible
under the Affordable Care Act to have DOC continue to pay its premiums
share.You are still responsible to continue payment of your share of the premium.
b. If you are receiving a check from DOC, and are paid a minimum of 80 hours, your
premium payments are automatically paid from your wages.
c. If you fall below 80 paid hours or are in LWOP, a letter will be mailed to you
detailing the coverage benefits you have, the amount necessary to maintain
coverage, and how to make the necessary payments each month. Please contact
payroll with questions.
d. If you choose not to continue core insurance coverage while you are out, you need
to request in writing to terminate coverage, but it will then affect any medical
services while you’re out.
5.
Optional Insurance Benefits
a. Continued payment and coverage for the following are handled the same as the
core benefits, except these may be paid for up to 1 year as long as your remain
employed, without the FMLA/SAIF/Military/ACA stipulation.
i. Accidental Death and Dismemberment
ii. Flexible Spending Account (Health and Dependent) can be prepaid with
prior approval or reenrolled in when you return to work.
iii. Domestic Partner Tax (if the partner continues to be covered for core
benefits)
iv. UNUM, Long Term Care Insurance
v. Assurant Insurance
vi. Optional Life Insurance, self and spouse and/or partner
vii. Dependent Life
viii. Short Term and Long Term Disability – if you currently have an active claim,
no premiums are due while the claim is open. These are only payable for 90
days.
b. If you are receiving a check from DOC, and are paid a minimum of 80 hours, your
premium payments are automatically recovered from your wages.
c. If you fall below 80 hours or are in LWOP, a letter will be mailed to you detailing the
optional coverage benefits you have, the amount necessary to maintain coverage,
and how to make the necessary payments each month. Please contact payroll at
the number above with questions.
d. If you choose not to continue optional insurance coverage while you are out, you
need to request in writing to terminate coverage, but it will then affect the use of
disability coverage while you’re out.
Created by Payroll/FMLA
Payroll Unit
Updated: 07/01/15
Fiscal Services
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