The one idea: If FMLA applies, the employer must keep paying its normal share of the premium and keep coverage identical during leave. The employee still owes their share, collected one of three ways.
When someone goes out on FMLA, employers ask the same first question: do we still have to pay our part of their health insurance? If the employer was contributing before the leave, the answer is yes.
First, does FMLA even apply?
FMLA covers private employers with 50 or more employees within a 75-mile radius, plus public agencies and public and private elementary and secondary schools regardless of size. The employer has to be covered and the employee has to be eligible before the coverage-continuation rules kick in.
The employer keeps paying its share
During FMLA, the employer must maintain group health coverage as if the employee were still working. If it paid 75% of the premium before, it pays 75% during leave. Coverage stays identical: no benefit cuts, no plan changes, no tier shuffling because of the leave.
Collecting the employee’s share
If the employee normally pays part of the premium by payroll deduction, the employer has to collect it during unpaid leave. FMLA allows three approaches: pay-as-you-go (the employee pays as it comes due), catch-up (the employer fronts it and collects on return), or prepayment (the employee pays ahead, rare). Whichever you use, put the method, timeline, and consequences in writing.
If the employee doesn’t pay
The employer can drop coverage for non-payment, but only after a written notice and a 30-day grace period warning that coverage will end. Even then, coverage must be reinstated on return, with no waiting period and no preexisting-condition limits.
Watch the non-FMLA trap
These rules apply only to FMLA-protected leave. For non-FMLA leave (personal leave, or extended medical leave after FMLA runs out), the contribution obligation depends on the employer’s policies, plan documents, carrier rules, and state law, and employers can often require the employee to pay the full premium, if the documents support it.
Why it matters to you
Employers get this wrong in both directions, cutting coverage they have to keep, or keeping coverage they don’t owe after FMLA ends. Knowing where FMLA stops protects your client from a claim on one side and an unnecessary cost on the other.
Key takeaways
- FMLA applies at 50+ employees within 75 miles (plus public agencies and schools).
- The employer keeps paying its normal share; coverage stays identical.
- Collect the employee’s share via pay-as-you-go, catch-up, or prepay, in writing.
- Drop for non-payment only after notice plus a 30-day grace period; restore fully on return.
- Non-FMLA leave follows different rules.
Check yourself
An employer paid 80% of an employee’s premium before FMLA leave. What must it pay during the leave, and what happens to coverage on return?
It must keep paying 80% and keep coverage identical during the leave, then restore coverage on return with no waiting period or preexisting-condition limits.