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Image of a generic Leave of Absence Form

Leave of Absence

Leave of Absence

You must notify the San Francisco Health Service System (SFHSS) when going out on a paid or unpaid Leave of Absence. There are several types of Leaves of Absence that have different health benefit eligibility requirements. Start by finding which type of Leave of Absence applies to your situation.

Type of Leave Health Benefit Eligibility
  • Family and Medical Leave (FMLA)
  • Worker’s Compensation Leave
  • Family Care Leave
  • Military Leave
Notify SFHSS as soon as your leave begins–within 30 days. You may elect to continue or waive health coverage for the duration of your approved leave of absence.
  • Personal Leave Following
  • Family Care Leave
If you have been on an approved Family Care Leave and are approved to extend this as a Personal Leave, you may elect to continue or waive health coverage for the duration of your approved Personal Leave. Contact SFHSS for more information.
  • Educational Leave
  • Personal Leave
  • Leave for Employment as an Employee Organization Officer or Representative
Notify SFHSS as soon as your leave begins–within 30 days. You may elect to continue or waive health coverage for the duration of your approved leave of absence. If your leave lasts beyond 12 weeks, you must pay the total cost of health coverage for yourself and any enrolled dependents. This includes your employee premium contribution plus your employer's premium contribution. Contact SFHSS for details.

 

Your Responsibilities

Notify your Supervisor and your Department’s Human Resources Professional (HRP) prior to your leave. If your leave is due to an unexpected emergency contact your HRP as soon as possible. Your HRP will help you understand the process and documentation required for an approved leave. Your HRP will also provide SFHSS with important information about your leave.

Contact the San Francisco Health Service System as soon as your leave begins–within 30 days. You may choose to continue or waive health coverage while on leave. If you continue coverage, you must pay employee premium contributions while you are on leave. If premium payments are not deducted from your paycheck while you are on leave you must pay SFHSS directly. Failure to do so will result in termination of your health benefits. Call SFHSS (415) 554-1750.

When leave ends, contact SFHSS to reinstate your benefits within 30 days of return to work. If you continued your health coverage while on an unpaid leave, you must request that SFHSS resume health premium payroll deductions. If coverage was waived or terminated while you were on leave, you must request that SFHSS reinstate your benefits and resume your payroll deductions.

 

Medical, Dental and Vision

While you are on an unpaid leave, premiums for health coverage cannot be deducted from your paycheck. To maintain coverage, you must pay premium contributions directly to SFHSS. Contact SFHSS within 30 days of when leave begins to either waive coverage or arrange for payment of premiums. Failure to do so can result in the termination of your health benefits, which may not be reinstated until you return to work or during the next Open Enrollment period. When you return to work, contact SFHSS immediately (within 30 days) to request that health premium payroll deductions be returned to active status.

 

Group Life Insurance

If you go on an approved leave due to illness or injury, any employer-paid group life coverage continues for up to 18 months. For other types of leave, group life coverage ends the last day of the month after the month in which your leave begins. Group life insurance resumes the first day of the coverage period after you officially return to work.

 

Long-Term Disability (LTD) Insurance

If you go on an approved leave due to illness or injury, any employer-paid Long-Term Disability (LTD) coverage continues for up to 12 months. Health premiums are not deducted from LTD payments. Call SFHSS to arrange to pay your premiums. For other types of Leaves of Absence, LTD coverage ends the last day of the month after the month in which your leave begins. LTD coverage resumes the first day of the coverage period after you officially return to work.

 

Domestic Partner Imputed Income

If you have a Domestic Partner enrolled on your health coverage while you are on unpaid leave, you will have a catch-up payroll deduction for taxation related to imputed income when you return from leave.

 

Healthcare Flexible Spending Accounts (FSA)

During an unpaid leave, no Healthcare FSA payroll deductions can be taken. To maintain your Healthcare FSA coverage, you must pay your Healthcare FSA contributions directly to SFHSS. Contact SFHSS within 30 days of when leave begins to arrange for payment of your Healthcare FSA contributions. You may suspend your Healthcare FSA if you notify SFHSS at the beginning of your Leave of Absence. Accounts that remain unpaid for three consecutive pay periods will be suspended retroactively to the first missed pay period. Your Healthcare FSA will be reinstated once you return to work. If you want to maintain your annual election amount for expenses incurred before and after your leave, you must notify SFHSS within 30 days of your return to work. Your payroll deductions will be increased and spread proportionally over the remaining pay periods in the Plan Year. If you do not contact SFHSS, your annual election amount will be reduced by the amount of contributions missed (if any) during your Leave of Absence.

 

Dependent Care Flexible Spending Account (FSA)

A Dependent Care FSA must be suspended while you are on a Leave of Absence. Claims incurred during leave are not reimbursable. To reinstate, you must notify SFHSS within 30 days of your return to work. Reinstatement of a Dependent Care FSA is only allowed on a go-forward basis. You may reinstate at the original bi-weekly Dependent Care FSA deduction amount, or you can increase bi-weekly deductions for the plan year. If you increase deductions, total Dependent Care FSA contributions for the year must equal and cannot exceed, the amount designated during the Open Enrollment period. If you do not notify SFHSS within 30 days of your return to work and request reinstatement of your Dependent Care FSA payroll deduction, Dependent Care FSA(s) will be canceled for the remainder of the plan year. There are no exceptions. 

 

Benefits Administered by the San Francisco Superior Court, San Francisco Unified School District,
or City College of San Francisco

If you are employed by the San Francisco Superior Court, San Francisco Unified School District or the City College of San Francisco, please contact your appropriate benefits office regarding your dental, FSA and/or disability insurance benefits which are not administered by SFHSS.