Connecticut FMLA and the Continuation of Medical Insurance: What are the Rules?

Last fall, school districts across Connecticut faced significant changes regarding employee leave rights when state law was revised to extend the Connecticut Family and Medical Leave Act (CT FMLA) to employees of “public school operators” whose positions do not require a license under Chapter 166 of the Connecticut General Statutes.  Among other topics, questions have arisen about employer obligations to continue group health insurance when an employee is out on CT FMLA leave. 

Long before these changes to state law, school districts were required (and are still required) to provide eligible employees with leave benefits in accordance with the federal Family and Medical Leave Act (“Federal FMLA”).  The Federal FMLA requires employers to continue group health insurance coverage for an employee on Federal FMLA leave (regardless of reason) under the same conditions as if the employee had not taken leave (i.e., at the employee’s normal cost share).  Unlike the Federal FMLA, the CT FMLA does not require employers to maintain an employee’s group health benefits during the period an employee is on CT FMLA leave to the same extent as if the employee was still working.  However, there may be other applicable laws, contractual provisions, or policies that do require such coverage when an employee is out on CT FMLA leave, even if no other leave is being run concurrently.  

State Law Requirements for Fully Insured Plans

Connecticut General Statutes § 38a-512a requires insurers to offer continuation of group health insurance coverage – at the employee’s normal cost share – to employees who are out of work due to their own illness or injury for up to the length of their leave or 12 months from the start of such leave, whichever is shorter. (After the applicable period ends, if the employee is still out on leave, then the employee may be charged the full premium rate under Connecticut General Statutes § 38a-512a.)  Importantly, this statute applies only to insured group health plans, not self-insured health plans.  In addition, this type of continuation coverage is required only when the employee takes leave for their own illness or injury, and not for other reasons (e.g., to bond with a newborn baby or care for an ill family member).  

State of Connecticut Partnership Medical Plan

Self-insured health plans, including the State of Connecticut Partnership Medical Plan (“State Plan”), are not covered by Connecticut General Statutes § 38a-512a.  However, the State has incorporated similar requirements into its State Plan document, thereby making it a contractual term for participating employers.  Specifically, the State Plan provides that the participating employer will continue to contribute its share of applicable premiums to maintain plan coverage for an employee on personal medical leave for the length of the injury or illness, up to 12 calendar months, as long as the employee pays their share of the cost premium to the employer on a timely basis. Similar to the state law (Connecticut General Statutes § 38a-512a) applicable to insurers, the 2025 State Plan does not require employers to continue to cover their cost share for leaves other than employee illness or injury, but does contain other requirements for employees on extended leave. For other types of leave (bonding, care for a family member, etc.), the 2025 State Plan rules are as follows:

• If the duration of leave is expected to be less than four months, an employee may stay enrolled in the State Plan by paying the full amount of the premium (employee and employer share) directly to the employer. 
• If the duration of leave is expected to be, or extends for, four months or longer, the employee will be offered continuation coverage under COBRA.

Self-Insured Plans

School districts that offer their own self-insured plans are not subject to Connecticut General Statutes § 38a-512a, nor are they bound by the State Plan’s contractual requirements.  However, such districts are well advised to carefully consider any relevant collective bargaining agreement or contract provisions, district policies, and/or the district’s approach to offering health and other types of insurance while employees are out on other types of leave when deciding how to approach insurance coverage for employees who are out on CT FMLA-only leave.

Takeaways

The rules that apply to health insurance coverage for employees on a leave of absence depend in part on what type of health insurance plan the district offers, the type of leave the employee qualifies for, and the reason for the employee’s leave.  As such, school districts have much to consider and sort through when determining whether and how they must provide group health insurance benefits when an employee is out on leave in light of the various statutory and contractual requirements, district policies, collective bargaining agreement provisions, and other applicable law.