Family and Medical Leave Act (FMLA)

Eligible employees may take Family and Medical Leave for the following reasons:

1. birth and care of the eligible employee's child, or placement for adoption or foster care of a child with the employee;
2. care of an immediate family member (spouse, child, parent) who has a serious health condition; or
3. care of the employee's own serious health condition. It also requires that an employee's group health benefits be maintained during the leave.

Employees may now also take:

1. Up to 12 weeks of leave for certain qualifying exigencies arising out of a covered military member's active duty status, or notification of an impending call or order to active duty status, in support of a contingency operation, and
2. Up to 26 weeks of leave in a single 12-month period to care for a covered service member recovering from a serious injury or illness incurred in the line of duty on active duty. Eligible employees are entitled to a combined total of up to 26 weeks of all types of FMLA leave during the single 12-month period.

Other changes to the final FMLA regulations include:

• Clarifying the criteria for Serious Health Conditions
  • For absence plus treatment, second visit must be within 30 days of onset of incapacity
  • For chronic conditions, must see healthcare provider twice per year
• New Certification of Health Care provider forms
  • Certification of Health Care Provider for Employee’s Serious Health Condition
  • Certification of Health Care Provider for Family Member’s Serious Health Condition
• Holidays
  • Paid holidays now count toward 12-week FMLA entitlement if leave is one week or more. They are not counted for shorter leave periods.
• New Employer Notices and Procedures
  • Available under the Forms section of the HR web page with a January 2009 revision date. Please discard any other forms pertaining to FMLA as they are no longer in compliance.

If you have any additional questions, please feel free to contact a member of your Benefits Team.

Dawn Swed 904.632.3018	Janet Meigs 904.632.3319	Sonya Polke 904.632.3316

Family and Medical Leave Forms
Employee Rights and Responsibilities (Form FMLA1)	Overview of an employee’s rights and responsibilities under FMLA.
FMLA Fact Sheet	Facts regarding FMLA.
FMLA Military Leave Fact Sheet	Facts regarding FMLA Military Leave entitlements.
FMLA Request Form (Form FMLA2)	This form is used to request leave under FMLA. Must be signed by employee and the employee’s Supervising Administrator then turned in to Human Resources for approval.
Certification of Health Care Provider for Employee’s Serious Health Condition (Form FMLA3)	This form is used when an employee is going out on FMLA for their own serious health condition. It must be completed by the employee and attending Health Care Provider then turned in to Human Resources before approval can be made.
Certification of Health Care Provider for Family Member’s Serious Health Condition (Form FMLA4)	This form is used when an employee is going out on FMLA to provide care due to a child, spouse or parent’s serious health condition. It must be completed by the employee and the child, spouse or parent’s attending Health Care Provider then turned in to Human Resources before approval can be made.
Certification for Serious Injury/Illness of Covered Servicemember (Form FMLA5)	This form is used when the employee is a child, spouse, parent or next of kin to an ill or injured covered servicemember of the Armed Forces, National Guard or Reserves and needs to provide care to that servicemember. It must be completed by the employee and attending United States Department of Defense Health Care Provider then turned in to Human Resources before approval can be made.
Certification of Qualifying Exigency for Military Family Leave (Form FMLA6)	This form is used when the employee is a child, spouse or parent of a covered servicemember on active duty or called to active duty in support of a contingency operation.