Leave of Active Service / Extension of Active Service
Another important aspect of our claim review will
be the guidelines regarding continuation of benefits when an employee
stops working for reasons other than termination of employment.
Generally, benefits cease when active service ceases. Active service
is considered to cease on the last day worked unless the result of a
temporary layoff, a temporary disability or any other bona fide leave
of absence.
The eligibility section of the Plan Sponsor’s Plan Document will be
reviewed to determine if an employee meets the requirements of an
active full-time employee. If an employee is no longer considered
active, the extension of active service provision of the Employer's
Plan Document will be reviewed to determine if coverage can be
extended. The extension of active service provision typically defines
sick time, Family Medical Leave Act (FMLA), leave of absence, etc.
If the employee does not return to work after the extension of active
service period, benefits may be continued under COBRA.
Once an employee exhausts the extension of active service period,
active Plan benefits should be considered terminated and the person
has had a qualifying event under COBRA. The employer can choose to
continue benefits for the applicable COBRA period or the remainder of
the COBRA period if the employer chooses to have the extension of
active service provision run concurrent with the COBRA period.
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