Understanding COVID-19 Leave and Benefits Requirements: 3 Scenarios

5 Compliance Changes to Review for 2020 Benefits Planning | Dan Kuperstein | Corporate Synergies
ERISA attorney Dan Kuperstein, a national expert on health & welfare benefits compliance, simplifies COVID-19 leave laws in 3 examples.
As Seen in BenefitsLink
As Seen In

This is a critical time in our country’s response to the COVID-19 pandemic. Employers and their HR and benefits departments are beginning to look at how they can reopen and bring their employees back to work. Understandably, they have questions about COVID-19 leave and benefits requirements.

As the expectation for employees to return to the workplace increases, my team and I are getting many questions. The questions we are receiving typically relate to the new Families First Coronavirus Response Act (FFCRA). Employers are also asking about the Family and Medical Leave Act (FMLA) and how this law may apply to the coronavirus crisis. We’ll present three scenarios with different types of leave requests, but first, here is a bit of background:

Types of Leave

There are three types of leave available under the federal laws described above:

  1. FMLA: unpaid leave
  2. FFCRA: emergency paid sick leave
  3. FFCRA: emergency paid family and medical leave

To keep things simple, we won’t review specific state and local leave laws. Instead, we’ll use examples and illustrations that are similar to those discussed in the U.S. Department of Labor’s (DOL) FAQ guidance on this topic.

Scenario Set-up

A hypothetical employer, XYZ Corp, has less than 500 employees and is subject to both the FFCRA and FMLA. On March 15, 2020, XYZ Corp initiates a furlough. As a result, beginning on that date:

  • Employees in Division A start working a reduced hourly schedule;
  • Employees in Division B have their hours reduced to zero (0); and
  • Employees in Division C are not subject to the furlough.

The furlough’s end date is May 15, 2020. On May 16, 2020 (the “recall date”), all furloughed employees are expected to return to XYZ Corp’s facility to work the same hours as prior to the furlough.

COVID-19 leave and benefits requirements vary by circumstance.

XYZ Corp’s health plan document contains eligibility terms that require the employer to offer health insurance coverage to full-time employees as defined by the ACA, and as defined over a 12-month measurement period. Therefore, XYZ Corp’s plan is in sync with the ACA.

Prior to March 15, 2020, the XYZ Corp HR team reviewed their employee handbook and benefits plan documents. The team decided to continue to offer health insurance to all furloughed employees retained on payroll during the furlough period and discussed this decision with their fully insured medical insurance carrier. The insurer agreed to allow XYZ’s employees to stay on the plan during the furlough period, even if the impacted employees no longer qualified as full-time under the plan document’s eligibility rules.

Three Leave Scenarios

1.

Abby Andrews works in Division A at XYZ on a reduced hourly schedule as required by the terms of the company’s furlough. She contacts her company’s HR rep on May 1, 2020, asking for emergency paid sick leave or emergency paid family and medical leave under the FFCRA.

The reason: she is severely ill and has been diagnosed with COVID-19. Her doctor has advised Abby to self-quarantine. Therefore, she cannot work or telework the reduced hours that she is required to fulfill during the furlough.

What kind of leave and benefits is Abby entitled to?
Under the FFCRA, Abby is entitled to take emergency paid sick leave because she has already been ordered to self-quarantine by a doctor, and she is severely ill with COVID-19.

How many hours of emergency paid sick leave is Abby entitled to, and how is this calculated?
Abby is entitled to take emergency paid sick leave hours that is equal to the number of hours that she currently works, on average, over a two-week period. However, if her hourly schedule is variable, or not easily determined, it gets more complicated.

Had Abby requested leave prior to the furlough while she was still a full-time employee, and assuming that she was regularly scheduled to work eight hours or more per day at that time, the calculation would have been much simpler.  Under the FFCRA, employers are required to provide emergency paid sick leave equal to the number of hours that the employee is currently scheduled to workover a two-week period, up to a maximum of 80 hours.

However, since she is working a reduced-hour schedule as a result of the furlough, the number of hours that she can take off may be variable and subject to change at the employer’s discretion.

Under the FFCRA, if the employee works an irregular schedule and it’s not possible to determine what hours she would normally work over a two-week period, the employer must estimate the hours. The estimate must be based on the average number of hours the employee was scheduled to work per calendar day (not a workday) over the six-month period ending on the first day of paid sick leave. This average must include all scheduled hours, including hours actually worked and the hours for which the employee took leave.

The amount of paid leave that Abby can receive is limited by her current reduced-hour schedule. She can only take this paid sick leave with respect to the reduced hours that she is assigned to work during the furlough. She can’t request that her employer take into account her pre-furlough schedule to get more paid sick leave hours. The DOL’s emergency paid sick leave guidance makes it clear that the furlough that’s causing her to work reduced hours is not the reason why she needs to take such leave. This is the case even if the furlough was caused by COVID-19.

How much is Abby entitled to get paid during her paid sick leave period?
Under the FFCRA’s emergency paid sick leave rules, Abby would be entitled to be paid at her regular rate of pay. The maximum amount of pay that she would be entitled to would be $511 per day, or $5,110 total over the entire paid sick-leave period.

What about emergency paid family and medical leave? What about unpaid FMLA?
Abby would not be entitled to paid family and medical leave, since it’s only available to employees who provide care for others due to school or daycare closures. This leave is not available for the employee’s own COVID-19 illness.

She would, however, be eligible for unpaid leave under the FMLA because this scenario meets the definition of a “serious health condition” under that law, assuming that Abby has worked for XYZ for the sufficient period of time required and meets the other FMLA eligibility criteria.1

With regard to health insurance benefits, XYZ must continue to offer health insurance to Abby during her leave period; this is required under the FMLA and FFCRA. XYZ had already agreed to offer health insurance to all furloughed employees anyway as per their agreement with their insurance carrier. This agreement should be reflected in the plan document’s certificate of coverage.

2.

Billy Bird works in Division B at XYZ. Due to the furlough, Billy is not working any hours now, but he is expecting to return to the facility and work normal hours on May 16 when the furlough is over.

He calls HR and says he needs to take care of his grandchild who lives with him. The child is too young to be left at home without a parent, and can’t attend school because a state-issued stay-at-home quarantine order has closed all schools.

Is Billy entitled to emergency paid sick leave or emergency paid family and medical leave? What about unpaid FMLA?
Unfortunately, no, not with respect to the paid types of leave under the FFCRA, at least not at the present time (during the furlough). Billy isn’t working any hours, and there are no hours available until after the furlough ends. As clarified in the DOL’s FFCRA guidance, since he’s not currently scheduled to work any hours due to the furlough, he is not entitled to emergency paid sick leave or emergency paid family and medical leave under the FFCRA.

Additionally, when it comes to unpaid FMLA, caring for a grandchild is not a permitted reason to take unpaid leave under that law. The person being cared for must be a “son or daughter” of the employee.2  These same FMLA rules (applicable to unpaid FMLA) also apply to emergency paid family and medical leave under the FFCRA, and accordingly, they would generally prohibit Billy from taking emergency paid family and medical leave to care for his grandchild since he is not a “son or daughter.”

When the furlough ends on May 16 and Billy is recalled to work, he can request to take emergency paid sick leave under the FFCRA. Here are the DOL regulations under the FFCRA that explain when emergency paid sick leave can be taken:

(1)  The individual being cared for is an immediate family member, roommate or a person with whom the employee has a personal relationship that creates an expectation that the employee would care for the person if quarantined.

(2) The individual being cared for must be subject to a federal, state or local quarantine or isolation order or has been advised by a healthcare provider to self-quarantine based on a belief that he or she has COVID-19, may have COVID-19, or is vulnerable to COVID-19.

These regulations clarify that the term “quarantine or isolation orders” includes a “broad range of governmental orders, including orders that advise some or all citizens to shelter in place, stay at home, quarantine, or otherwise restrict their own mobility.”

3.

Christy Crable works in Division C. She is not subject to the XYZ furlough and is working regular hours. Christy contacts her HR department and says that she is concerned about taking public transportation during the pandemic. She has a sore throat, but not a fever, and hasn’t been diagnosed with COVID-19. She hasn’t been quarantined, nor has she visited a doctor about the sore throat.

Is Christy entitled to emergency paid sick leave or emergency paid family and medical leave? What about unpaid FMLA?
No, Christy is not entitled to any of these types of leave under any of these laws. Concerns about taking public transportation during the pandemic, and experiencing some symptoms that might be coronavirus-related, or that might not be, is not enough of a reason for an employee to take any of these types of leave. Her HR department will need more information about her circumstances to determine if she qualifies to take leave under any of these laws.

1XYZ Corp will be entitled to reimbursement for paying for Abby’s emergency paid sick leave through refundable tax credits made available by the IRS. Additional information about how these tax credits work can be found on the IRS website, and the IRS has helpful FAQ guidance on this topic.

2More specifically, under applicable FMLA regulations, the term “son or daughter” means “a biological, adopted, or foster child, a stepchild, a legal ward, or a child of a person standing in loco parentis, who is under 18 years of age; or 18 years of age or older who is incapable of self-care because of a mental or physical disability.”

Corporate Synergies Logo
Corporate Synergies is a national insurance and employee benefits brokerage and consultancy. Crafting creative plan designs, enhancing efficiencies and resolving compliance risk. Risk management strategies and insurance solutions for clients across a broad range of industries.

Share

Related Content

Latest Content

Want More?

On Demand Webinars​

View any of our past recorded webinars. Note that the recorded webinars are not eligible for CE credits.

Current Events Calendar ​

Learn from respected experts while you earn CE credits for select continuing education events, free of charge.​

Further Learning​

Never miss another event! Receive email alerts for upcoming events and service offerings.​

LIKE WHAT YOU'RE READING?

Get Notified!

We will send important benefits-industry information directly to your inbox as it becomes available, including accredited CE events.

Matt McCuen

National Executive at Imagine360

Matt McCuen is an industry veteran, with over 30 years of experience in the self-funded space.  

As the National Marketing Executive for Imagine360, Matt works with self-funded employers across the nation to improve the benefits they offer to their employees and families. 

Imagine360 is the leading provider of employer-sponsored health plan solutions that deliver deep cost savings and concierge member support. Leveraging 50+ years of expertise, Imagine360’s solutions combine the financial benefits of reference-based pricing, best-in-class member support, and health plan administration.  

Greg Santulli

CEO of Rx Valet

Greg Santulli is the CEO and Co-Founder of Rx Valet, an industry leading Pharmacy Cost Savings company. Greg has over 30 years of experience in healthcare and pharmacy. His leadership has positioned Rx Valet as the one of the leading providers of Pharmacy Cost Containment, low-cost access to medications and a successful pharmacy benefit manager. His company’s approach is to engage all parties involved to provide unprecedented results. 

Mitch Lamoriello

VP Wealth Advisor at Advus Partners

Mitchell has innovation in his bones. He understands the unique challenges and circumstances clients face in their financial lives, and is passionate about discovering new ways his family firm can help serve a changing investor and investment marketplace.

As an investment specialist, Mitchell sits on the Advus’ investment committee. He also is responsible for assisting in the firm’s qualitative and quantitative due diligence process and contributing to the research on capital markets and global economic conditions. His knowledge base in investments provides him with a strong foundation to help answer client questions and navigate issues with their portfolio. As he spends more time with clients, Mitchell understands the importance of achieving goals and has expanded his knowledge, skills and approach beyond investments to encompass holistic financial planning.

andy rhea

Andy Rhea

President of Align Risk Solutions

Andy is the President of Align Risk Solutions. Prior to the formation of Align, Andy served as General Counsel to the Captive Insurance Division for the Tennessee Department of Commerce and Insurance. He began his legal career with the Mississippi Insurance Department and in private practice. He is a licensed attorney (in both Tennessee and Mississippi) and holds the Associate in Captive Insurance designation. Andy is very active in various captive insurance associations, currently serving as the President of the Tennessee Captive Insurance Association. Andy is a graduate of Mississippi State University where he received a BBA and MBA, and he earned his law degree from the University of Mississippi. During the feasibility and formation phases of Align’s process, Andy is involved in all regulatory, business plan and application functions. Ongoing, Andy is responsible for corporate governance, regulatory matters, and client relationships. 

Andrew Zito

President/CEO – Advus Fincancial Partners

Andrew has always been fascinated by complex things. The more complicated something is, the more he wants to understand it and fix it. From applying technology to solve business problems to working with plan sponsors to untangle complicated situations, he thrives on finding efficient and effective solutions.

Andrew oversees the operations of Advus, translating the firm’s vision and objectives into actionable processes. His responsibilities encompass technology solutions, business processes, service standards and human resources. He also is directly responsible for the retirement plan division and settingits strategic direction.

Andrew specializes in the qualified retirement plan aspect of the Advus business. Throughout his career, he has worked with retirement plans in a variety of different capacities. He began his career as an intern at Advus (formerly LAMCO Advisory Services, Inc.) assisting with compliance testing. He then spent several years working on platform conversions for retirement plans before moving into his present consulting role. Within the retirement plan space, he specializes in complex plan situations including plan mergers, spinoffs, complex regulatory audits, M&A activity and error corrections.