Yes, you keep your health insurance while on FMLA leave. Federal law requires your employer to maintain your group health plan coverage on the same terms as if you had never left work. This applies for the full duration of your FMLA leave, which can last up to 12 weeks in a 12-month period.
What Your Employer Must Cover
Your employer is legally required to continue every type of coverage included in your group health plan: medical, surgical, hospital care, dental, vision, mental health counseling, and substance abuse treatment. If you had family or dependent coverage before your leave, that stays in place too. The coverage cannot be reduced, and your employer cannot impose new conditions, higher copays, or larger deductibles that don’t also apply to employees who are still working.
If your employer changes or upgrades the health plan while you’re on leave, you’re entitled to those changes on the same terms as everyone else. For example, if the company adds dental coverage to the plan, you get access to it. If open enrollment happens during your leave, your employer must notify you so you can make changes. And if the plan allows you to switch from single to family coverage after a qualifying event like the birth of a child, that option must be available to you during leave as well.
You Still Pay Your Share of Premiums
FMLA protects your coverage, but it doesn’t make it free. Whatever portion of the premium you were paying before your leave, you’re still responsible for during it. If your leave is paid (because you’re using accrued vacation or sick time, or your employer offers paid FMLA), your premiums will typically continue through payroll deduction as usual.
If your leave is unpaid, you’ll need to arrange another way to pay. Your employer can ask you to pay on the same schedule as payroll deductions would have occurred, follow the same payment timeline used for COBRA, prepay through a cafeteria plan, or use another method you both agree on. Your employer must give you advance written notice explaining exactly how and when payments are due. One thing they cannot do is charge you extra administrative fees on top of your normal premium amount.
What Happens If You Miss a Payment
If you fall behind on premium payments during unpaid FMLA leave, your employer can eventually drop your coverage, but only after following a specific process. You get a grace period of at least 30 days from the date a payment is due. Before canceling your coverage, your employer must mail you a written notice at least 15 days in advance, stating the exact date coverage will end unless payment is received. So in practice, you have meaningful warning before losing your insurance.
If your coverage does lapse because of missed payments, you’re entitled to full reinstatement when you return to work, with no waiting period, no new medical exam, and no exclusions for pre-existing conditions.
What Happens When You Return to Work
When your FMLA leave ends and you come back, you’re entitled to the same position you held before (or an equivalent one) with the same benefits, pay, and terms. Your health insurance picks back up on the same terms that existed before your leave, or on the current terms if the plan changed for the entire workforce while you were out. Benefits like life insurance, disability insurance, retirement contributions, sick leave, and vacation must also be restored at the same level.
If you opted out of health coverage during your leave, you can reinstate it when you return without going through a new qualifying period or enrollment window.
If You Don’t Return to Work
FMLA leave isn’t a qualifying event under COBRA on its own. But if you decide not to come back after your leave ends and notify your employer, that decision triggers a COBRA qualifying event. At that point, you can elect COBRA continuation coverage and pay the full premium yourself to keep your insurance active.
Your employer may also be able to recover the share of premiums they paid on your behalf during your FMLA leave if you don’t return to work. However, this generally doesn’t apply if you can’t return because of a serious health condition or other circumstances beyond your control.
Who Qualifies for FMLA Protection
These protections only apply if you’re eligible for FMLA in the first place. To qualify, you must have worked for your employer for at least 12 months, logged at least 1,250 hours during the 12 months before your leave starts, and work at a location where the employer has at least 50 employees within a 75-mile radius. Public agencies and public or private elementary and secondary schools are covered regardless of their size.
If you don’t meet these thresholds, your employer isn’t bound by FMLA rules on health insurance continuation. In that case, your coverage during leave would depend on your employer’s own policies and, potentially, state-level family leave laws that may offer separate protections.