The DOL has issued new Family and Medical Leave Act (FMLA) forms with slightly updated information (a new expiration date of 5/31/18, and a notice that health providers cannot provide information regarding genetic testing). Please replace all FMLA forms with those below. Specific changes to each form are noted as follows:
- The updated expiration date is found on all forms referenced below.
- The updated genetic testing information is referenced in the new WH-380-E, WH-380-F, WH385, and WH-385-V medical certification forms found below.
The following information is taken from the DOL website as a reminder of the parameters of the FMLA. (DOL.gov)
Family and Medical Leave Act
The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Eligible employees are entitled to:
- Twelve (12) workweeks of leave in a 12-month period for:
- the birth of a child and to care for the newborn child within one year of birth;
- the placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement;
- to care for the employee’s spouse, child, or parent who has a serious health condition;
- a serious health condition that makes the employee unable to perform the essential functions of his or her job;
- any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty;” or
- Twenty-six (26) workweeks of leave during a single 12-month period to care for a covered service member with a serious injury or illness if the eligible employee is the service member’s spouse, son, daughter, parent, or next of kin (military caregiver leave).
The federal FMLA applies to 50 or more employees within a 75 mile radius of the place of employment.
Useful FMLA Links
We have provided the direct links to the update forms; the DOL webpage can be found HERE
- WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition (PDF)
- WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition (PDF)
- WH-381 Notice of Eligibility and Rights & Responsibilities (PDF)
- WH-382 Designation Notice (PDF)
- WH-384 Certification of Qualifying Exigency For Military Family Leave (PDF)
- WH-385 Certification for Serious Injury or Illness of Covered Servicemember — for Military Family Leave (PDF)
- WH-385-V Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave (PDF)
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