455 N.

City front Plaza Drive, 13th Floor

Chicago, IL 60611-5322
Phone: 1. 877.FMLA.MOO (877-365-2666)
Fax: 1.877.309.0218
https://fmlasource.com

Your Next Steps - Family Member Absence

During Your ABSENCE

What you need to know:

 Make FMLASource your first point of contact for your absence. Live, knowledgeable representatives are available
to guide you through the absence process between the hours of 7:30am and 9:00pm CST.
 If your absence is denied you may contact FMLASource via fmlasource.com, fmlacenter@fmlasource.com, or 877-
365-2666 for further review and explanation of the denial.
 When we receive documentation for your absence: If your absence has been certified by your health care provider,
you will receive a notification that we have the documentation. A decision packet will be sent via your preferred
communication method within 48 hours of receipt of the documentation.
 When we don’t receive documentation for your absence in time: You can still submit paperwork after the deadline
– we will process it according to your company’s policy regarding late paperwork, which may result in your absence
being delayed or denied.
 When you want to check the status: If you haven’t received a notification or decision, you can check the status of
your claim at any time by logging on to www.fmlasource.com.
 Tracking your absence dates:
o Continuous Absence: You do not need to call and report the time you’re out as the time is already reported.
o Intermittent Absence: For intermittent time use, the regulations require you to provide advance notification
whenever possible. You are required to report each intermittent absence to your department leader by
following normal departmental call-in procedures and to FMLASource within forty-eight (48) hours of your
absence.

What you need to do:

 Documentation for your absence: Take the Medical Certification form to your attending physician for completion.
Verify that the physician fully and accurately completed all fields on the Medical Certification form and submitted it to
FMLASource on your behalf within the 15-day certification due date as stated in the Initial Request Packet.
 Keep an eye out for your decision: Keep an eye out for your decision packet – sent via email or postal, depending on
what you requested – and any notifications about documentation for your claim.
 To change your absence dates: You will receive a touch base email or call 2 weeks before the end of your absence.
You can simply reply to our outreach - or contact us at any time via www.fmlasource.com,
fmlacenter@fmlasource.com, or 877-365-2666 to request an adjustment.
 At the end of your absence:
o Continuous Absence:
 Returning to work early: If you are returning to work earlier than anticipated, you must notify your
manager two (2) business days prior to your expected return date. Failure to notify your manager
may delay your return to active employment.
 Keep an eye out for your RTW notification: You will hear from us 2 weeks before the end of your
absence – via email or a phone call depending on your preferred method of communication – so we
can confirm you will be returning to work on time or make any adjustments as needed.
o Intermittent Absence:
 Recertification: If at any time you exceed your approved intermittent frequency/duration or the
situation necessitating your absence changes, you may be asked to have your absence recertified.
This request will come via your preferred method of communication (email or postal).
 To renew your absence: You will receive a touch base email or call 2 weeks before the end of your
absence. You can reply to our outreach - or contact us at any time 30 days prior to the end of your
absence via www.fmlasource.com, fmlacenter@fmlasource.com, 877-365-2666 to request a
renewal.

® ®
FMLASource, Inc. is a ComPsych company.

© 2014 ComPsych Corporation. All rights reserved. This information is for educational purposes only. It is always important to consu lt with the appropriate professional on medical, legal, behavioral
or other issues. As you read this information, it is your responsibility to make sure that the facts and ideas apply to your situation.
 455 N. City front Plaza Drive, 13th Floor
Chicago, IL 60611-5322
Phone: 1.877.GO2.FMLA (1.877.462.3652)
Fax: 1.877.309.0218
https://fmlasource.com

Your JOB, PAY, and BENEFITS

What you need to know:

 Reductions in force: If you return within the specified absence protection period, you will be entitled to return to the
same job or an equivalent position offering equivalent pay, benefits and working conditions. However, you have no
greater right to reinstatement or other benefits than if you had been continuously employed during the FMLA absence
period. For example, if your job is impacted by a loss of contract, position elimination, or substantial reduction in work
load.
 Moonlighting while on absence: You may not work for another employer while on family or medical absence. Such
outside employment is grounds for immediate termination.
 Any false answers or statements knowingly made in connection with your application for FMLA will be sufficient
grounds for disciplinary action up to and including termination.
 Entitlement: The requested leave will be counted against your annual FMLA entitlement. FMLA absence is up to a
total of twelve weeks (unless the absence is to care for an injured service member which has a 26 week allotment) of
unpaid job-protection, which is taken during a rolling twelve-month period measured backwards from the date you use
absence under FMLA.

What you need to do:

 To maintain your benefits: Your Company will continue to maintain your coverage under any group health plan while
you are on FMLA absence on the same conditions as coverage would have been provided if you had been actively
working. You must pay your portion of the premium while on FMLA. If you are eligible to receive paid time off, bonuses
and/or commissions during your absence, your portion of the health plan premium will continue to be deducted as a
regular payroll deduction. If your absence is unpaid, you will be required to arrange a method of payment or pay all
insurance premiums prior to starting your absence. Your health care coverage may cease if your premium payment is
more than thirty (30) days late.
 To receive state benefits: If you work in a state that offers additional benefits, you may be entitled to benefits through
the state. For more information, please refer to any attached applicable documents.
 Paid and unpaid absence: You will be required to substitute (run concurrently) any unused, accrued paid time off
(PTO) with your unpaid absence, so as to be paid for all or a portion of the absence. Once your PTO has exhausted,
the remainder of your absence will be unpaid.

© 2014 ComPsych Corporation. All rights reserved. This information is for educational purposes only. It is always important to consult with t he appropriate professional on medical,
legal, behavioral or other issues. As you read this information, it is your responsibility to make sure that the facts and ideas apply to your situation. 2