- Employee FMLA Request Form
- CFRA Notice
- FMLA Notice
- Pregnancy Disability Notice
- State Disability Brochure
- Paid Family Leave Brochure
- Certification of health Care Provider for Employee's Serious Health Condition
- Certification of health Care Provider for Family Member's Serious Health Condition
- Employee Rights and Responsibilities
- Certification of Qualifying Exigency For Military Family Leave
- Certification for Serious Injury or Illness of a Current Servicemember - -for Military Family Leave
- Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave
Qualifying Life Events
If you experience a Qualifying Life Event, you will have 30 days from the date of the event to make changes to your benefits. According to the IRS, Qualifying Life Events include Marriage, Divorce, adding a dependent (birth, adoption or domestic partner), death of a spouse or dependent, changes in your spouse’s health care coverage, or change in your or your spouse’s full-time employment.
Any changes as a result of these life events must conform to the “Consistency Rule” which means that the change must be consistent (“on account of and corresponds”) with the qualifying event. For example, if one of the employee’s children no longer qualifies as a dependent, the employee can drop that child from coverage, but cannot make changes affecting other dependents or a spouse.
If you experience one of the above-qualified family status changes during the year, please contact Human Resources within 30 days of the event. Additionally, please note that if you become divorced or your dependent reaches age 26, your dependents may become eligible for COBRA continuation coverage and you must notify the HR department within 30 days of these status changes