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Marsha411JD
Marsha411JD, Lawyer
Category: Employment Law
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Experience:  Licensed Attorney with 28 yrs. exp in Employment Law
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Our company offers a health insurance opt-out incentive, paying

Customer Question

Our company offers a health insurance opt-out incentive, paying employees $200 a month if they use their spouses’ insurance plans. We now have an employee going out on maternity leave. Do we have to keep paying her $200 per month?
Submitted: 4 years ago.
Category: Employment Law
Expert:  Marsha411JD replied 4 years ago.
Hello,

If she is still an employee and is still under her spouses' insurance plan, then yes you would continue to pay her even if she is on maternity leave. The only reason you wouldn't is if you had included something in your written "opt-out" plan that said that employees who are temporarily disabled and out of work will not receive payments under the plan.
Customer: replied 4 years ago.

I actually I myself took my maternity leave last year, but I did not get $200 monthly incentive. I had been using my spouse's insurance and I returened to work timely manner.

 

I did not get any written notice from the company; however, I was told that simply company does not need to pay. Is there any law that I can show it to my boss?

 

What do you mean by "if you had included something in your written "opt-out" plan that said that employees who are temporarily disabled and out of work will not receive payments under the plan"?

Expert:  Marsha411JD replied 4 years ago.
Hello again,

To answer your last question first, it means just what it says, if the employer had written in their policies that all employees, not just those on maternity leave, who are out of work under STD, LTD or even FMLA, will not receive the payments, then they have given notice of their pay out requirements. This OPT OUT plan is not one that is required under statute so the employer is free to set the requirements for payment under it. However, they can't distinguish between someone who is on maternity leave versus someone who is on medical leave for another reason. That would be a violation of the Pregnancy Discrimination Act. That Act would also be what you would use to show your employer that they are not allowed to treat you any differently just because you were on maternity leave. In addition, you would use their own written policy that apparently doesn't have any exceptions written into it. In other words, this is an issue of potential discrimination under the PDA if they are paying for other people out on medical leave. If they aren't , then this is a contractual issue and you will have to use their own written policies to show them that there are no exceptions in the plan. If they then refuse to pay you, then you will have to file a small claims court action for breach of contract.

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