February 2018, Vol. 2

Continuing health insurance coverage for employees on unpaid leave

by April Mabry

Q: How long can an employee on unpaid leave continue to receive health coverage through the district?

A: For districts with TRS-ActiveCare, an employee on an approved, unpaid leave absence (e.g., workers’ compensation, temporary disability, or family and medical leave) is eligible to continue his or her health coverage through the district for the maximum period specified by Teacher Retirement System (TRS) rules. The maximum period ends on the last calendar day of the sixth month following the month in which the individual is placed on leave-without-pay status. For example, an employee who goes on leave January 8 is eligible to continue coverage through the district until the end of July, which is six calendar months after February 1. Because coverage extends through the end of the calendar month, the maximum coverage period is often longer than six months.

Coverage beyond the maximum period is not allowed by TRS rules (34 TAC §41.40). When eligibility for coverage as an employee ends (e.g., at the end of the maximum period), the individual may be eligible to continue coverage under COBRA (Consolidated Omnibus Budget Reconciliation Act). Additional information on COBRA coverage is available in the HR Library.

Employees in districts that do not participate in TRS-ActiveCare can continue coverage for the time period specified in the district’s health plan.

Responsibility for payment of premiums during leave depends on the leave designation. If the leave is paid or designated as family and medical leave (FML), the district is required to pay its portion of health benefit premiums at the same level it was before leave started. Otherwise, the employee is responsible for paying the entire premium during any unpaid leave that isn’t FML unless local policy provides otherwise.