Elective Surgery & FMLA: What You Need to Know in 2023
Elective surgery and its impact on FMLA (Family and Medical Leave Act) in 2023 is a significant topic of concern for eligible employees. It is important to understand the definition of a serious health condition and its relation to elective surgery and FMLA leave.
What is Elective Surgery and FMLA?
Elective surgery and FMLA are two interconnected concepts that might affect an employee’s medical leave eligibility. Elective surgery refers to any surgical procedure that is not considered an emergency or medically necessary, such as cosmetic surgery or joint replacements.
FMLA, on the other hand, is the Family and Medical Leave Act, a federal law that allows eligible employees to take up to 12 weeks of unpaid leave in a 12-month period for certain medical and family-related reasons without fear of losing their job or health insurance. When it comes to elective surgery and FMLA, the question arises whether an employee undergoing elective surgery is eligible for FMLA leave or not.
What is Elective Surgery?
Elective surgery is any surgery that is scheduled in advance and is not considered an emergency. Elective surgeries are typically performed on a patient’s request and are not medically necessary, though some may improve a patient’s quality of life.
Examples of elective surgeries include cosmetic surgeries like breast augmentation or LASIK eye surgery, as well as joint replacements, weight loss surgery, and fertility treatments. Since elective surgeries are pre-planned, employees undergoing them might be eligible for FMLA leave if they meet the eligibility criteria.
What is FMLA?
FMLA refers to the Family and Medical Leave Act, a federal law that allows eligible employees to take up to 12 weeks of unpaid leave in a 12-month period for certain medical and family-related reasons. The eligible employee can take FMLA leave for their own serious health condition, including elective surgeries that require overnight hospital stays or continuing treatment by a healthcare practitioner, as well as for the birth or adoption of a child, to provide care for a family member with a serious health condition, or for certain military family leave reasons.
FMLA is designed to protect an employee’s job and health insurance while they take the necessary time off from work to deal with a medical or family-related emergency or situation.
How Does FMLA Cover Elective Surgery
Elective surgery is the type of surgery that a patient chooses to undergo when it is not necessarily medically required. This could be anything from plastic surgery to bariatric surgery.
If an eligible employee requests FMLA leave for elective surgery that requires an overnight stay in the hospital, it would still meet the definition of a serious health condition under the FMLA regulations.
Coverage of Overnight Elective Surgery Under FMLA
For the surgery to be covered under FMLA, it must meet the necessary requirements. These requirements include that the patient must have a serious health condition, and that they must provide at least 30 days’ notice of the leave (when feasible).
If these requirements are met, FMLA allows an eligible employee to have up to 12 workweeks of protected leave over a 12-month period. During this time, the employee retains their health insurance coverage under the FMLA, as well as other benefits provided by the employer, such as paid vacation leave, sick leave or paid time off.
The employer must also maintain the employee’s position while they are off work on FMLA leave.
Coverage for Non-Overnight Elective Surgeries Under FMLA
Non-overnight elective surgeries may still be covered under FMLA regulations. This would depend on the severity of the surgery and how it impacts the employee’s ability to perform their job.
Again, the surgery must meet the definition of a serious health condition and require the employee to be off work for more than three days. FMLA regulations stipulate that employees must give their employers at least 30 days’ notice (when feasible) before taking leave for an elective surgery that does not require an overnight hospital stay.
Eligibility for FMLA Coverage for Elective Surgery
When it comes to elective surgery, understanding employee eligibility for coverage under the Family and Medical Leave Act (FMLA) is crucial.
Eligibility Criteria for FMLA Coverage
For employees to qualify for FMLA coverage, they must have worked for their employer for at least 12 months and at least 1,250 hours within the past 12 months. Additionally, the employer must have 50 or more employees within a 75-mile radius of the employee’s worksite.
FMLA and Medical Certifications for Elective Surgeries
Medical certifications are an essential component for employees to obtain FMLA coverage for elective surgeries. Employers have the right to request a medical certification from a healthcare provider to confirm that the employee requires the surgery and needs FMLA leave.
Managing Employee Elective Surgery Requests Under FMLA
Employee elective surgery requests that require or result in an overnight stay in the hospital may beeligible for coverage under FMLA regulations as serious health conditions. Employers can navigate employee requests for elective surgeries under FMLA by following specific steps and best practices.
Managing Employee Requests for Elective Surgeries Under FMLA
Employers must recognize employee requests for elective surgeries as potential serious health conditions which may be covered under FMLA regulations. An eligible employee may take up to 12 workweeks of FMLA leave in a 12-month period without fear of losing their job.
Employers can manage employee elective surgeries under FMLA by verifying the eligibility of their employees and the validity of the employee’s request for leave. Employers must also follow FMLA regulations for notice requirements and obtaining medical certifications.
Employers must transfer employees who have FMLA-covered conditions to another job within the organization only if the transfer will not negatively affect the employee’s pay or benefits, and the new job has equivalent duties and status.
Best Practices for Managing Elective Surgeries Under FMLA
Employers can manage employee elective surgeries under the FMLA by following various best practices. Human resources professionals can lead by ensuring that the FMLA year conforms to a “rolling” year.
This involves looking backward 12 months from each employee’s first day of FMLA leave, rather than a fiscal or calendar year. Employers must verify employee eligibility and that the reason for leave qualifies under FMLA.
Employers must enforce employee notice requirements, including the requirement for the employee to provide their employer with 30 days’ notice, or notice as soon as practicable. Employers must also use medical certification requested from a healthcare provider, and may require a second or third opinion from another provider if they have questions about the validity of the original certification.
Additionally, employers must require employees to schedule their leave to avoid disruptions to their job duty requirements, and may also transfer the employee to an equivalent job that does not negatively affect their pay or benefits during their leave.
FAQs Related to Elective Surgery and FMLA
Can Employees Take FMLA Leave for Elective Surgeries?
What is the Duration of FMLA Leave for Elective Surgeries?
Can an Employee be Denied FMLA Leave for Elective Surgery?
Conclusion
In summary, if an eligible employee requests FMLA leave for elective surgery that requires or results in an overnight stay in the hospital, the leave request would be considered a serious health condition and covered under FMLA regulations. Requests for leave to undergo cosmetic or elective surgeries can sometimes fall under the ADA and should not automatically be dismissed or denied.
Employer best practices for managing FMLA leaves include confirming employee eligibility, using medical certifications, and enforcing employee notice requirements. It is important for companies with 50 or more qualified employees to have human resources professionals on staff who can manage FMLA.
With proper management of FMLA leave, employees can receive necessary medical care without putting their job security at risk.
