Column 89 Where you get married matters! New rules


Where you get married matters!  New rules


Reader of this column will notice that our industry is highly regulated.  One of the problems with this is that there are often conflicting laws that cover an issue.  So the situations will be tested in different courts and challenged until there is some sort of final outcome that gives benefits administrators and insurers the guidance they need to run their plans. 


Most recently the definition of "spouse" was further clarified, at least for the purposes of FMLA (Family and Medical Leave Act).  Essentially the new rule updates the definition of spouse so that if an employee was in a legal same sex marriage based on the "place of celebration" then the marriage is legal for FMLA purposes and the benefits apply.  Simply, if a couple is married in a state that allows same sex marriage, but then resides in a state that does not allow same sex marriage, the couple will still be eligible for the benefits under FMLA.

The effective date for the rule is March 27, 2015

            FMLA provides important benefits for families, such as the allowing an employee to take up to 12 workweeks of unpaid leave in the event of a qualified situation.  This effects eligible employees of private sector employers who have 50 or more employees in 20 or more work weeks in the current or preceding calendar year.  There are some special exceptions, but in general these are the employers effected.

It also effects public agency employers and schools regardless of the number of employees it employs. 

The 12 weeks of unpaid leave can be for the following reasons according to the Department of Labor:


*The birth of a son or daughter or placement of a son or daughter with the employee for adoption or foster care;

• To care for a spouse, son, daughter, or parent who has a serious health condition;

• For a serious health condition that makes the employee unable to perform the essential functions of his or her job; or

• For any qualifying exigency (pressing or urgent situation) arising out of the fact that a spouse, son, daughter, or parent is a military member on covered active duty or call to covered active duty status.  This situation may extend the leave to 26 work weeks.


Employees must comply with their employer's usual procedures for requesting leave and provide enough information and time (usually 30 days if possible) for their employer to determine whether the FMLA may apply.


The employer may not use this as a reason to terminate employment and in fact must restore the employee to the same or equivalent job upon return.  Employers are require to continue group health insurance coverage for an employee on FMLA under the same condition as if they were still working.  This means the employee can be required to continue to pay their share of premium. The employer can set a 30 day grace period for the employee and cancel coverage if they do not pay within that time.




I received a reminder from Anthem's PR department:

WellPoint changed its name to Anthem, Inc. back in December. He was kind enough to cut me some slack:  "I know it's only a couple months, so it's very understandable that some people refer to us by our former name. I just wanted to let you know for future reference".  I apologize for any confusion that may have caused.  For most of my career, many people were often confused and thought Blue Cross and Blue Shield were the same company.