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The basics of maternity leave
If you're thinking about starting a family, it's a good idea to expect the unexpected—especially when it comes to your health insurance (/articles/healthinsurance/). You should expect changes in your health status, employment status, and health insurance benefits. What will happen if your doctor advises you to take time off work when you get pregnant? Or if he orders you to stay in bed during the middle of your pregnancy?
It's important to know the details of your employer's policy regarding maternity leave and other pregnancy-related benefits.
Federal law does not require employers to provide maternity leave or other pregnancy-related benefits.
It can be difficult to figure out which benefits apply to your situation and how to coordinate them. After all, an employer is not required to offer health insurance to its workers and if it does, it can choose to eliminate or limit maternity leave. This is also the case with short-term or long-term health insurance. Federal law does not require employers to provide maternity leave to their employees–although many do.
First, you should carefully read your health plan's Explanation of Benefits (EOB). If you have questions after reading the manual, write them down. Take the list to the human resources director or health plan administrator, as they can help you find the answers.
Second, familiarize yourself with the concepts of pregnancy-related benefits. For example, maternity leave covers the period of time in which a woman is disabled by her pregnancy, childbirth or a related condition, and cannot report to work. It is different from paternity leave. Paternity leave is absence from work unrelated to a medical condition that is taken voluntarily by men or women to care for a newborn or newly adopted child.
Benefits and the Law Against Pregnancy Discrimination
The federal law that governs maternity leave is called the Pregnancy Discrimination Act (PDA). Under this law, pregnant women must be treated in the same manner as other applicants or employees with similar abilities or limitations.
When determining eligibility for maternity and pregnancy leave and administering pregnancy-related health insurance benefits, there are certain rules that employers and health plan administrators must follow:
- Your employer must not highlight conditions related to your pregnancy to determine your ability to work. However, he can ask you for a medical examination by following procedures that he requires of other employees. For example, if your employer requires all of its employees to submit a statement from their doctor regarding their inability to work before granting leave, the employer may require you to do so as well.
- If you are temporarily unable to perform your job due to your pregnancy, your employer must treat you the same as any other temporarily disabled employee. For example, by providing you with modified assignments or alternative jobs or by giving you maternity leave or unpaid leave.
- Your employer must hold your position for the same length of time that jobs are held for someone who is sick or on disability leave.
- If your employer offers health insurance that covers maternity disability benefits, your health insurance must cover expenses for pregnancy-related conditions in the same way it covers other medical conditions.
- If you have health insurance that covers pregnancy-related health care expenses, you must reimburse them exactly the same as expenses incurred for other medical conditions.
- The amounts payable by the insurer may be limited only to the extent of the costs for other conditions. No additional, increased or higher deductibles can be imposed due to pregnancy.
- Pregnancy-related benefits cannot be limited only to employees who are married.
- If your employer provides benefits to employees on leave of absence, it must extend the same benefits to those who leave for pregnancy-related conditions.
- If you are pregnant, your employer must treat you the same as any other temporarily disabled employee with respect to rank increase and recognition, vacation accrual, pay increase, and temporary disability benefits.
How Maternity Disability Coordinates with the Family or Medical Leave Law
Once you've determined your eligibility for pregnancy-related benefits, you should also be aware of how these sometimes coordinate with the Family and Medical Leave Act (FMLA). This federal law entitles eligible employees to 12 weeks of unpaid leave for certain family and medical reasons (such as the birth of a child) during any 12-month period, according to the US Department of Employment.
Paid leave and FMLA work simultaneously, and time away from work counts against both.
FMLA is more complicated in certain situations where an employer is permitted to require an employee requesting FMLA leave to use accrued paid leave (such as paid vacation, personal time, disability maternity or sick leave) as a substitute for FMLA leave. In these cases, paid leave and FMLA leave are used simultaneously, the time you take is deducted from both. That's why it's important that you understand the benefits offered by your employer and whether the company requires employees to use paid leave as a substitute for FMLA leave, which is unpaid.
Employers have their own responsibilities under FMLA. Under federal law, an employer who wishes to count paid leave as part of the 12 weeks of unpaid FMLA leave must notify the employee within two days of learning of the employee's request for FMLA leave. If the employer misses this deadline, the employer cannot retroactively designate the leave as part of FMLA leave. Only the part of the leave after notification can be designated as FMLA leave and count toward the 12-week entitlement.
For example, if your employer finds out on Monday morning that your paid leave beginning that day is due to FMLA reasons, they must make their designation by Wednesday morning. If your employer waits until the following Monday, the leave taken the previous week does not count as FMLA leave and you will start the second week with a full 12 weeks of FMLA eligibility remaining.
In order to qualify for FMLA benefits, an employee must have worked for the employer for the previous 12 months and have logged at least 1,250 hours.
If you are pregnant, what does it mean to qualify for maternity disability and FMLA benefits? Your employer may require that your pregnancy-related benefits be counted along with FMLA leave. For example, let's say you have a total of 12 weeks of paid vacation and disability leave. If you take it, you will have used your disability leave and FMLA benefits without pay. They will not give you an extra 12 weeks of unpaid leave.
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