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IAM 2.13.7

Section: Public Service Health Care Plan (PSHCP) - Continuous Coverage

Subsection: On Return to Duty

Rule

When a member returns to duty after a period of authorized leave without pay LWOP, unauthorized LWOP, seasonal lay-off or suspension, the contribution deductions resume automatically from pay (without submission of an application) in the month the employee returns to work. The coverage is effective from the first day of the month following the month in which the first contribution is deducted from pay.

Comment

When a member of the PSHCP did not pay the contributions to continue coverage during a period of unauthorized LWOP, suspension or seasonal lay-off, he is not covered under the Plan during that period. However, on return to duty to the indeterminate or substantive position, deductions and coverage automatically resume as stated in the above rule.

Exception

If an employee accepts a specified period appointment while on LWOP from his indeterminate position, he can have his PSHCP contributions deducted from his determinate salary if he has maintained his coverage during the LWOP by paying contributions as required, regardless of the length of the specified period appointment. Therefore, the employee can continue his coverage under the PSHCP even though the appointment is for six months or less.

If however, an employee accepts a specified period appointment while on LWOP from his indeterminate position, and he has NOT maintained his coverage under the PSHCP during the LWOP, then the employee's coverage under the PSHCP can only be reinstated if:

  1. he is appointed for a specified period of more than six months; or
  2. if he is appointed for a specified period of six months or less, and is later appointed for another specified period when the employee completes six months of continuous employment.

These cases will be treated as if the employee is returning to duty. Therefore, the PSHCP deductions resume from pay in the month the employee is first eligible to reinstate coverage (i.e. when appointed for a specified period of more than six months, or when appointed for a specified period of six months or less and later appointed for another specified period of six months or less - the employee becomes eligible after completing six months of continuous employment). Coverage is effective the first of the following month.

Because the employee's coverage under the PSHCP was suspended during LWOP, if he wishes to reinstate his coverage during the specific period appointment, he must retain the same level of hospital coverage as he had when he was covered under the Plan as an indeterminate employee.

Also, because the coverage is being reinstated under the PSHCP, an application form is not required. Personnel offices must inform employees that they must indicate whether or not they wish to have their coverage under the PSHCP reinstated, the month they are first eligible for reinstatement. Otherwise, coverage under the PSHCP continues to be suspended until they return to their substantive position.

Once the employee resumes his period of LWOP, if he had originally suspended his coverage under the PSHCP for that period, then he is NOT entitled to reinstate his coverage until he returns to his substantive position, or possibly another specified period appointment.

Last Update: October 2012