--- title: Health Care Coverage for an Employee out on WC Leave description: When an employee is on workers' compensation leave due to a work related injury or illness, is the employer required to maintain the employee's group health coverage? image: https://koppingerins.com/hubfs/Free%20Shutterstock%20Images/work%20comp%204.jpg --- [![Koppinger & Associates logo](https://koppingerins.com/hs-fs/hubfs/01609-KA-Logo-CC-1.png?width=1800&height=384&name=01609-KA-Logo-CC-1.png "Koppinger & Associates logo")](https://koppingerins.com) [![Koppinger & Associates logo](https://koppingerins.com/hs-fs/hubfs/01609-KA-Logo-CC-1.png?width=1800&height=384&name=01609-KA-Logo-CC-1.png "Koppinger & Associates logo")](https://koppingerins.com) - [Home](https://koppingerins.com) - Solutions - [Business insurance & P&C](https://koppingerins.com/business-insurance-pc-solutions) - [Employee benefits & HR](https://koppingerins.com/employee-benefits-and-hr-solutions) - [Knowledge Center](https://koppingerins.com/blog) - [About](https://koppingerins.com/about) - [Contact](https://koppingerins.com/contact) - [HR Library](https://auth.zywave.com) # Health Care Coverage for an Employee out on WC Leave October 04 2022 Categories: [Group Employee Benefits](https://koppingerins.com/blog/tag/group-employee-benefits) ![Health Care Coverage for an Employee out on WC Leave](https://koppingerins.com/hubfs/Free%20Shutterstock%20Images/work%20comp%204.jpg) When an employee is on workers' compensation leave for an extended period due to a work related injury or illness, is the employer required to maintain the employee's group health coverage?  Many factors determine the answer including: - the terms of the group health plan - the applicability of federal law, including the Family and Medical Leave Act (FMLA) and COBRA - Employers should consider the following when determining their obligation to continue group health insurance. **If the employee is also on leave under FMLA or other state medical leave:** - *Health care coverage is protected under these types of leaves* - *Protections will run concurrently with the workers' compensation leave* - *The employee's health care coverage will continue under the same terms as prior to the leave* - *The employer continues to pay their portion of the health care premium* - *The employee continues to pay his or her portion of the health care premium* - *Employers cannot increase the portion of the employee premium because they are on FMLA leave* **If the employee is not eligible for FMLA leave:** - *Eligibility requirements of the health care coverage will dictate* - *If the health care plan* ***requires*** *an employee to be working a determined number of hours to be eligible for coverage, with no exceptions for leave outside of FMLA, then* If the group health plan **does** allow for coverage during such leaves of absence, the employer would follow those guidelines for keeping the employee on the plan and for how long. Once FMLA or other state leaves are exhausted, the health care eligibility requirements should again be referenced.  If the employee is not able to return to work and is no longer eligible for coverage due to a reduction in hours, COBRA should be offered if the employer is subject to COBRA.  Being aware of health care eligibility requirements for employees recovering from workplace injury or illness can help prevent potential legal action. ***Contact Koppinger & Associates for information or questions regarding the interaction between work comp, FMLA, and continuation rights under COBRA.***       - - - - [mailto:?subject=Health%20Care%20Coverage%20for%20an%20Employee%20out%20on%20WC%20Leave&body=Health%20Care%20Coverage%20for%20an%20Employee%20out%20on%20WC%20Leave%20https://koppingerins.com/blog/do-i-need-to-maintain-group-health-care-coverage-for-an-employee-out-on-work-comp-leave](mailto:?subject=Health%20Care%20Coverage%20for%20an%20Employee%20out%20on%20WC%20Leave&body=Health%20Care%20Coverage%20for%20an%20Employee%20out%20on%20WC%20Leave%20https://koppingerins.com/blog/do-i-need-to-maintain-group-health-care-coverage-for-an-employee-out-on-work-comp-leave) [Previous post](https://koppingerins.com/blog/you-might-be-a-joint-employer-and-not-realize-it) [All posts](https://koppingerins.com/blog) [Next post](https://koppingerins.com/blog/current-form-i-9-version-expiring-october-31-2022) ## Related Articles #### [Increase Employee Retention and Improve Productivity](https://koppingerins.com/blog/increase-employee-retention-and-improve-productivity) #### [Next Steps - Recalling Employees Back to Work - Koppinger & Associates](https://koppingerins.com/blog/next-steps-recalling-employees-back-to-work) #### [The Overlooked Coverage That Could Save You Millions](https://koppingerins.com/blog/the-overlooked-coverage-that-could-save-you-millions) [![01609-KA-Logo-WH](https://koppingerins.com/hs-fs/hubfs/01609-KA-Logo-WH.png?width=300&height=64&name=01609-KA-Logo-WH.png "01609-KA-Logo-WH")](https://20500700.hs-sites.com/) 3060 Commerce Dr. Suite 4 Fort Gratiot, MI 48059 At Koppinger & Associates, we are a team of dedicated insurance advisors who put the needs of our clients first. 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