Training Session Outline Why Third Party Administrator FMLA
Refresher Integrated Intake Overview FMLA Leave Management Process
Roles & Responsibilities Unum Contact Information
Slide 3
The Value of a Third Party Administrating FMLA Leave
Streamlines the FMLA process by consolidating all leave
administration to one source Maintains confidentiality and
impartiality of decisions - Calling Unum to request leave does not
guarantee approval - Employees must satisfy FMLA eligibility and
certification requirements - OU has final discretion regarding
leave decisions Reduces lost time and lessens the impact on
productivity
Slide 4
FMLA Refresher FMLA provides employees with up to 12 weeks of
unpaid* leave for the following reasons: Employees Own Serious
Health Condition/Disability Care of a Family Member (Spouse,
Parent, Child) with a Serious Health Condition Care of a Child due
to Birth, Adoption, or Foster Care Placement To qualify for FMLA
leave, an employee must: Work for the employer for 12 months Work
1,250 hours in a 12-month period * Employees must use accrued Sick
Leave/ Personal and may be required to use accrued vacation during
any otherwise unpaid FMLA. Any paid time off used during leave will
be counted against the available leave under the FMLA.
Slide 5
FMLA Refresher OUs FMLA Calculation Method: The 12-month period
is measured backward from the date an employee takes any FMLA
leave. Example: Employee requests FMLA leave on April 1, 2008. The
employee must have at least 1250 hours worked since April 1, 2007
to be eligible. Job Protection Under the FMLA: Employees who return
to work on or before the expiration of FMLA leave should be
reinstated to their same or equivalent job with the same pay,
benefits, and terms and conditions of employment. Employees on FMLA
have no greater right to reinstatement or other benefits and
conditions of employment than if they had not taken leave.
Slide 6
Leave Schedule Full/Continuous Leave Leave that is
full-time/continuous (e.g., 12 consecutive weeks) Reduced Schedule
Leave Schedule of leave that reduces the number of hours an
employee works daily or weekly (e.g., full-time to part-time)
Intermittent Leave Leave taken periodically and may be taken from
less than an hour to weeks at a time
Slide 7
Leave Reasons & Certification Types Employees or family
members serious health condition Medical Certification Form Newborn
(Paternity) Copy of application for birth certificate Adoption or
Foster Care Court document with date of placement
Slide 8
Certification: Serious Health Condition Six Serious Health
Condition categories under the FMLA: Hospital Care Absence Plus
Treatment Pregnancy Chronic Conditions Requiring Treatments
Permanent/Long-term Conditions Multiple Treatments
Slide 9
Integrated Intake Overview
Slide 10
Customer Disability and Leave Management Line at Unum NOTE:
Intake line at Unum will reference disability claim. Employees
should follow this process to report all leave types, including
FMLA, Extended Sick Leave, and STD.
Slide 11
Leave/Claim Intake Process When employee calls Unum, the
following information will be requested: Name and social security
number or employee id number Date of birth Complete address and
phone number Company Marital status and number of dependents
Occupation (job title) Physicians name, address and phone number
Brief description of medical condition Cause of medical condition
(illness or injury) or need for leave Your last day worked and
first day absent from work due to condition Date and description of
illness or injury (disability claims only) Date of your first
visit, your most recent visit and your next scheduled visit with
your physician for this condition (disability claims only) Date you
expect to return to work (if known) or the actual date if already
returned to work
Slide 12
Leave/Claim Intake Process During telephonic intake for leave
claims, the caller is also instructed to provide the Attending
Physician with a signed authorization to release information to
Unum so that the medical information needed to process the claim
can be obtained.
Slide 13
FMLA Leave Management Process
Slide 14
FMLA Leave Management - Process to Request New Leave Within 2
business days of the telephonic leave request, Unum will mail a
packet to the employee containing: Notice of eligibility or
ineligibility for FMLA leave FMLA Rights & Responsibilities If
eligible: Conditions of leave and employee obligations Medical
Certification form if applicable Permission to Contact form if
applicable
Slide 15
Medical Certification Requirements FMLA leave with a concurrent
STD/Extended Sick Leave claim No medical certification form is
requested for the FMLA leave FMLA will be approved concurrently
with the STD/Extended Sick Leave claim If the STD/Extended Sick
Leave claim is not approved, Unum will send a subsequent request
for medical certification if needed FMLA leave only If eligible, a
medical certification form or appropriate documentation is
requested ***Certifications are reviewed by leave specialists.
Slide 16
Day 1 - Report of family medical leave Certification is due 15
days from the date of request Day 16 - Certification Reminder
letter sent to employee if certification has not been submitted
Certification due date extended 7 calendar days Day 23 - FMLA leave
denial letter sent to employee if certification not submitted
Incomplete certifications received are returned to employees with a
certification due date extension Certification due date is extended
7 calendar days from original due date or 10 calendar days from the
date of the incomplete letter, whichever is later NOTE: This
process includes absences for employees on leave due to workers
compensation claims. FMLA will run concurrently if the employee is
eligible and approved per the process above. FMLA Certification
Timeline for absences NOT being processed for disability
Slide 17
FMLA Leave Management Denial Reversal Process If an employee
submits a complete and qualifying certification: Within 15 calendar
days of an FMLA leave denial -Unum will send an email to UHR
contact notifying that a complete/qualifying certification has been
received and that the denial will be reversed in 24 hours. Beyond
15 calendar days of an FMLA leave denial: -Denial never reversed
absent extenuating circumstances If a denial is not reversed, leave
may be approved prospectively from the date complete/qualifying
certification was received.
Slide 18
FMLA Leave Management Certification Review and Advice to Leave
Certification Screening Checklist Incomplete Certifications
Returned to employee (with copy and explanation) Validity
Questioned Verify authenticity Request Recertification Request 2nd
Opinion (on original certifications)- Employer pays for this
Clarification Needed for Complete Certifications Nurse Case Manager
will contact the doctor (with signed permission to contact)
Complete Certification Evaluated for qualification under FMLA
regulations leave law FMLA Approvals from Short-term Disability
Approvals, where possible
Slide 19
FMLA Leave Management - Ongoing Unum monitors approved/pending
FMLA leaves and/or Extended Sick Leave/Disability claims through
Return to Work Request medical recertification as needed and
allowed by law Requests for extensions After minimum duration
specified by health care provider has passed Every 45 days for
indefinite or unknown durations Change in circumstances On-going
validity of absences questioned Receive and verify intermittent
hours reports
Slide 20
FMLA Leave Management Return to Work Verify Return To Work
plans and remind employees to submit Return to Work Authorization,
when appropriate Confirm actual return to work date with the
manager and HR contact via email
Slide 21
Key Capabilities of Unums Program Single dedicated toll-free
number for integrated intake Compliance with federal regulations
Ongoing advisement and support of internal legal counsel regarding
compliance with federal regulations Centralized and automated
eligibility determination and leave tracking Consistent
administration across workforce Advice to Leave Service Measure,
track, analyze and report all FMLA leaves Integrated
FMLA/STD/Extended Sick Leave processes, where appropriate Nurse
Case Manager clinical advisory expertise FMLA/STD Integrated
reporting Intermittent hours tracking and reporting
Slide 22
Roles & Responsibilities
Slide 23
Employer Obligations FMLA Notify the employee of his/her FMLA
rights within 2 business days of becoming aware of the possible
need for leave. Notify the employee when lost time from work is
being counted as FMLA time. Return the employee to the same or
equivalent job when they return from leave. Disregard FMLA lost
time whenever taking disciplinary action for excessive
absences.
Slide 24
Employee Responsibilities Contact Unum immediately to report
Family/Medical leaves or Disability claims at 1-866-779-1054.
Notify supervisor of leave request Supply requested certification
to Unum within specified timeframes Provide Unum with signed copy
of Authorization to Release Information. Maintain contact with Unum
and Supervisor while on leave Notify Unum and Supervisor of any
changes in return to work status or date
Slide 25
University Human Resources Responsibilities Provide employee
with leave brochure as requested Ensure that all family/medical
leaves are reported to Unum immediately If an employee cannot, will
not, or has not reported a leave to Unum, UHR should do so in order
to facilitate compliance. Facilitate an ongoing dialogue with Unum
regarding status determinations, problem/suspect leaves and other
extenuating circumstances
Slide 26
Contact Information Leave Management Center FMLA/Leave
Representatives may be reached by calling the toll free number 1-
866-779-1054 and choosing the option for inquiring about an
existing family/medical leave Fax number: 800-447-2498 Unums
Benefits Center (Short- term Disability) Unit Call toll free number
1- 866- 779-1054 and choose the option to inquire about an existing
disability claim