Free Sample Family And Medical Leave Policy
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Sample Family And Medical Leave Policy

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Family and Medical Leave Policy


This policy formally implements the provisions of the Federal Family and Medical Leave Act of 1993 (FMLA).

Employer ABC will provide up to 12 weeks of unpaid leave of absence in a 12-month period as required by FMLA upon request by an eligible employee for:

·         Birth and first-year care of a child,

·         Adoption or foster placement of a child,

·         Care of a spouse, child, or parent with a serious health condition; or

·         The employee's own serious health condition.

Twelve-month period defined: A rolling 12-month period measured from the date an employee uses any Family and Medical Leave.

Child defined: A biological, adopted son or daughter, foster son or daughter, stepchild or child of a person standing in loco parentis, who is under 18 years of age or 18 years of age or older and dependent upon the employee for support by reason of a mental or physical disability.

Eligible employee defined: Any person employed by ABC for at least  months.

Health care provider defined: A physician of medicine or osteopathy authorized to practice medicine or surgery (as appropriate) by the State in which the physician practices, or any other person determined under the Act to be capable of providing health care services.

Incapable of self care defined: The individual requires constant assistance and supervision to provide daily self-care.

Intermittent leave defined: Leave taken in separate periods of time due to a single illness or injury.  Leave of periods can be from one hour or more to several weeks.

Key employee: A salaried FMLA-eligible employee in the highest paid 10% of all employees of ABC.

Parent defined: The biological parent of an employee or an individual who stood in loco parentis to an employee when the employee was a child.

Reduced leave: A leave that reduces an employee’s number of hours worked per workweek or workday.

Serious health condition defined: An illness, injury, impairment, or physical or mental condition that requires in-patient hospital care, hospice or residential medical care facility; or continuing treatment by a health care provider.

Spouse defined: A husband or wife as defined or recognized under state law.

If both the husband and wife are employees, a combined total of twelve weeks of leave in a twelve month period is permitted if the leave is for the birth and first year care of a child, adoption or foster placement of a child, or to care for a common parent with a serious health condition.

Leave for birth, adoption or foster care placements of a child can begin before the birth or placement of the child.  Entitlement to this leave expires 12 months after the date of birth or placement.

Leave taken to care for a spouse, child or parent with a serious health condition or for the serious health condition of the employee may be taken intermittently when medically necessary.

If an employee requests an intermittent leave, ABC can require the employee to transfer temporarily to an alternative position that accommodates the leave better than the employee’s position.  The employee will be qualified and receive the equivalent pay and benefits.

Requests for a leave require a written request to the appropriate supervisor.  Employees shall give ABC  days advanced notice of the need due to the birth or adoption of a child or foster care, or for planned medical treatment.  When advance notice is not practicable, notice will be given as soon as the employee knows he/she will need a leave.

Requests for leave for serious health condition will be supported by a written medical certification from an appropriate health care provider.  Certification shall be provided within  calendar days of the leave request.  ABC reserves the right to require employees obtain the second opinion of a health care provider designated or approved by ABC.  ABC will pay any costs resulting from the second opinion.  If the second opinion differs from the first opinion, ABC will require, at its expense, a third opinion from a health care provider designated and approved by the employee and ABC.  During the leave, ABC can request additional medical certification no more than every  days.  Employees on a personal illness leave shall provide evidence of fitness to return to their duties.

An employee returning from leave will return to the position held before the leave, or to an equivalent position (benefits, pay, and other terms and conditions of employment).  However, ABC may deny restoration of employment if denial is necessary to prevent substantial and grievous economic injury to ABC’s operations.

During the leave, ABC will maintain the employee's group health insurance plan at the pre-leave level and conditions and ABC will pay its share of the employee's group health insurance.  The employee will make arrangements with Benefits to pay his/her share of the cost of benefits.  Benefits will cancel any benefit if the employee has not made appropriate payment after such payment is past due for 30 days.  The employee is obligated to repay ABC any health insurance premiums ABC pays for the employee if the employee does not return to work.  Exception: The reason for not returning to work is due to the continuation, recurrence or onset of a serious health condition that would entitle the employee to leave under this policy.  ABC will continue to cover the cost of group-life insurance, accidental death and dismemberment insurance, and long-term disability insurance otherwise provided to employee during a leave when the leave is due to the serious health condition of the employee.

Employees taking leave under this policy must exhaust any available sick leave, annual leave and/or personal leave prior to taking leave without pay for the balance of the twelve-week period.

Employer ABC reserves the right at anytime to modify, alter, or amend this Policy in whole or in part.  ABC shall have the unlimited right to amend this Policy at any time, retroactively or otherwise, and to the extent that may be necessary to meet any legal requirement(s).

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