Do You Have to Pay for Health Insurance While on FMLA Leave?

Employees are sometimes surprised to learn that taking time off under the Family and Medical Leave Act (FMLA) doesn't automatically mean their employer will cover their health insurance premiums in full.

While the law protects your right to keep your group health benefits during leave, it doesn't relieve you of your normal obligation to pay your share of the cost.

Understanding what's required—and what options you have—can help you avoid unexpected bills or lapses in coverage.

Your Right to Health Insurance During FMLA Leave

The FMLA is a federal law that allows eligible employees to take up to 12 weeks of unpaid, job-protected leave each year for specific family and medical reasons. During this time, your employer must maintain your group health insurance under the same terms as if you were actively working.

That means your coverage—such as medical, dental, and vision insurance—must remain in place. However, your employer doesn't have to pay your share of the premiums unless it normally does so. In most cases, you're required to continue paying the same portion of the premium you paid while working.

Example

Suppose your company pays 75% of your health insurance premium and you pay 25% through payroll deductions.

While you're on FMLA leave, your employer must continue paying its 75% share. But you're still responsible for your 25% share, even if your leave is unpaid.

How Employers Can Collect Premium Payments

When you're receiving paid time off—such as vacation or sick leave—your share of the premium can still be deducted from your paycheck as usual. Once your paid leave runs out, you'll need to make separate arrangements to pay your portion directly.

The FMLA allows employers some flexibility in how they collect these payments. Common methods include:

• Pay-as-you-go. You continue paying your share on the same schedule as regular payroll deductions—for example, every two weeks.
• Prepayment. You may agree to prepay your share before starting your leave. This can be done through a larger payroll deduction or a lump-sum payment.
• Catch-up payments. You and your employer can agree that you'll repay missed premiums after returning from leave.

Your employer must notify you in advance about the payment schedule and method. They can't require prepayment unless you agree to it.

What Happens If You Don't Pay Your Share

If you fail to make premium payments on time, your employer can cancel your coverage, but only after giving you at least 15 days' written notice. The notice must state the payment due date and explain that your coverage will end if payment isn't received.

If your coverage is cancelled for nonpayment during FMLA leave, your employer must still restore it once you return to work—under the same terms as before your leave—without waiting periods or new enrollment forms.

If you know you'll struggle to make premium payments while on unpaid leave, talk to your HR department before your leave begins. You might be able to negotiate a different payment schedule or use accrued paid leave to cover some of your costs.

How FMLA Leave Interacts With Other Laws

FMLA rules only apply to employers with 50 or more employees. Some states have their own family and medical leave laws that may provide broader rights or additional protections.

For example, several states have their own family leave or temporary disability insurance programs that allow employees to take paid or partially paid leave. In these states, employers often must continue contributing to employees' health insurance premiums while the employee is on approved state leave, even if the federal FMLA doesn't apply.

If your employer is subject to both federal and state leave laws, the rule that offers you greater protection applies. Check with your state labor department or a local employment attorney to learn about your specific rights.

What If You Don't Return to Work After FMLA Leave?

If you don't return to work after your FMLA leave ends, your employer might require you to repay the premiums they paid on your behalf during your leave, unless the reason for not returning is beyond your control. Examples include:

• continuing health problems that prevent you from working, or
• a serious family medical condition.

However, if you decide not to return for personal reasons unrelated to your FMLA-qualifying condition, your employer can usually seek reimbursement for their share of premiums.

Keeping Coverage Intact: Practical Steps

Here are some ways to avoid coverage gaps while on leave:

1. Confirm your payment amount. Ask HR to confirm exactly how much you owe and when payments are due.
2. Set reminders. Mark due dates on your calendar so you don't accidentally miss a payment.
3. Discuss prepayment. If possible, prepay some or all of your share before your leave begins.
4. Keep communication open. Notify your employer promptly if your situation changes—for example, if you'll be extending your leave or returning earlier than planned.

By planning ahead, you can maintain continuous health coverage and avoid reinstatement issues when you return to work.

Bottom Line

The FMLA protects your health insurance while you're on leave—but it doesn't make it free. You're still responsible for your normal share of the premiums. To keep your coverage uninterrupted, coordinate with your employer before your leave begins, set up a payment method that works for you, and stay on top of deadlines.

Frequently Asked Questions About Health Insurance and FMLA

Does my employer have to keep paying for my health insurance during FMLA leave?

Yes, but only the same share they normally pay when you're working. If you usually contribute to your premium, you must continue to do so.

Can my employer cancel my health insurance while I'm on FMLA leave?

Only if you don't pay your required share after proper notice. They must give you at least 15 days' warning before canceling coverage.

What if I can't afford to pay my share during unpaid leave?

You might be able to work out a payment plan or prepay your share before your leave starts. Some employees use accrued vacation or sick time to cover the costs.

Will my coverage automatically restart when I return to work?

Yes. Even if your coverage was canceled for nonpayment, your employer must reinstate it immediately once you return, with no waiting period or re-enrollment.

What happens if I decide not to return after my leave?

Your employer may ask you to repay their share of premiums unless your failure to return is due to circumstances beyond your control, such as a medical condition.

Do these rules apply if my employer has fewer than 50 employees?

Not under federal law, but some states have their own family leave laws that cover smaller employers. Check your state's requirements.

Can I drop coverage while I'm on leave and re-enroll later?

You can choose to drop coverage, but it's usually best to keep it. If you drop it voluntarily, you might have to wait until the next open enrollment period to sign up again.

Does FMLA leave affect my other benefits, like life insurance or disability insurance?

Your employer isn't required to maintain non-health benefits during unpaid leave, but many choose to. Ask your HR representative which benefits will continue while you're away.