Leaves of Absence Non-FMLA - Carondelet.org

Title: Personal Leave of Absence (non-FMLA)Section: Management of Human ResourcesDept. of Origin: Human ResourcesEffective Date: April 1, 2000Last Review Date: April 1, 2012NETWORKPOLICY & PROCEDURESignature:Daisy JenkinsExecutive VP Chief Human Resources/Administrative OfficerI. POLICY STATEMENTTo provide Carondelet Health Network (CHN), Carondelet Medical Group (CMG) and CarondeletSpecialist Group (CSG) associates with a leave of absence or time away from work withappropriate manager approval. Personal Leave of Absence (PLOA) may be for either medical ornon-medical reasons not meeting criteria or eligibility for Family Medical Leave Act (FMLA)leave.II.III.IV.PURPOSETo allow an Eligible Associate an approved leave of absence when the need arises (1) due to theAssociate’s own medical condition when the Associate does not qualify for FMLA leave or (2)for a personal reason.DEFINITIONSEligible Associate: An Associate who is budgeted to work at least 24 hours a week or 48 hours perpay period who has been employed for a minimum of six (6) months. Human Resources (HR) mayapprove exceptions to the length of employment criteria under extenuating circumstances (or asotherwise required by law). PRN and temporary associates are not eligible for PLOA.Rolling Twelve (12) Month Period: The twelve (12) consecutive months beginning with the firstday of approved PLOA and looking back the previous twelve (12) consecutive months.Types of Workforce Relationships: See Types of Workforce Relationships policy.ROLES AND RESPONSIBILITIES1. An Associate on PLOA leave may not have their job guaranteed upon return to work.2. Maximum total length of PLOA is three (3) months (or for a period of time as otherwiserequired by law) in a Rolling Twelve (12) Month Period. If an associate cannot or does notreport back to work at the end of their approved leave, his or her employment will end.3. PLOA is not for intermittent leave. The purpose of PLOA is to provide personal leave time foran Eligible Associate who needs to have at least seven (7) consecutive days off.4. PLOA is an unpaid leave of absence unless the leave qualifies for either Extended Illness Bank(EIB) or Short Term Disability (STD) or if the associate has Paid Time Off (PTO) or awardedHoliday Hours that must be used during the course of the leave. Refer to the Benefits sectionof this Policy below and the Continuation of Benefits Policy.PLOA REQUEST PROCESS:1. An Associate requesting PLOA for a personal/non-medical reason must complete andsubmit a Personal Leave of Absence/Non-Medical Request Form to his/herManager/Supervisor for review prior to the PLOA effective date. The reason for thePLOA and expected return to work date must be indicated on the PLOA request form.2. An Associate requesting PLOA for medical reasons must complete and submit a FamilyMedical Leave (FMLA) application along with an Extended Illness Bank (EIB) or ShortTerm Disability (STD) application form to Associate Health & Wellness.3. If PLOA is requested for a personal/non-medical reason, the Manager/Supervisor isresponsible to work with their HR Generalist to review and approve the PLOA request.Personal Leave of Absence (non-FMLA)Page 1 of 4

4. The HR Generalist will check for outstanding work commitment agreements or loanagreements and will forward the request to the Leave Coordinator.5. If the request is approved, the Leave Coordinator will provide a leave of absence approvalnotice to the associate and their manager/supervisor.6. The Manager/Supervisor will submit an Associate Action Form (AAF) to the LeaveCoordinator prior to the effective date of the leave.7. If the leave is approved for a personal/non-medical reason, the associate must turn in allCarondelet property; including his/her badge prior to the PLOA effective date.8. The Manager/Supervisor is responsible for completing an Associate Action Form (AAF)if the associate returns to work. The AAF is sent to the Leave Coordinator for trackingreturn to work status.9. The Leave Coordinator will terminate the associate if he/she does not return to his/herposition following the last day of approved leave or, if the associate’s position was filled,the associate fails to communicate an active interest in finding a new position.10. If the leave is approved for a personal medical reason for which the associate does notqualify for FMLA job protection, EIB or STD are approved and paid through the standardEIB or STD Policies.BENEFITS:1. If the leave is approved for a medical reason, the associate will be paid from availableExtended Illness Bank (EIB) hours or Short Term Disability (STD) in accordance with theEIB or STD Policies. PTO and any available awarded Holiday Hours will be paid during thefirst week of an EIB case or during the first two weeks of an STD case. If accrued EIB isexhausted, accrued PTO must be used until exhausted or until the associate returns to work.2. If the leave is approved for a non-medical reason accrued PTO must be used until exhaustedor until the associate returns to work.3. Benefits will remain active during the approved leave period through return to workprovided benefit premiums are paid in full through payroll deduction or through self paymentby the Associate. If the Associate fails to return to work at the end of their approved leave orwithin the additional 30 day period allowed to secure another position, the Associate will beterminated from employment. Benefits will terminate as follows: Flexible Spending Accounts,Life and Long Term Disability Insurance benefits end on the day of employment termination.Medical/dental/vision/Hyatt Legal benefits end on the last day of the month in whichtermination occurs. If the Associate is on medical leave and eligible for Long Term Disability,information will be processed with the LTD Administrator for evaluation and approval ofLTD benefits. The Associate is responsible to pay their portion of the benefit premium to theBenefits Office on each pay date that the Associate does not have enough EIB or PTO hoursto cover their benefit portion of premium. Failure by the Associate to assure full and timelybenefit premium payments will result in benefit termination. Loss of benefits is a Continuationof Benefits/COBRA-qualifying event.4. If benefits are terminated due to non-payment of premium, the Associate will be responsibleto contact the Benefits Department to determine eligibility for reinstatement of coverage uponreturn to work.V. SPECIAL CONSIDERATIONS1. PLOA will not be granted to an Associate to take time off from CHN to secure another jobopportunity.2. The Associate is required to maintain contact with their Manager/Supervisor, HR Generalistor the Leave Coordinator to provide an updated status as to their intended return to work dateor their need to extend their leave.3. An Associate approved for medical leave is responsible for providing medical updates toAssociate Health & Wellness (AHW) and must be cleared by AHW prior to returning to work.4. Prior to returning to work, the Associate must contact their Supervisor/Manager to verify iftheir position is available. If their position was filled, the Associate will have 30 days to applyPersonal Leave of Absence (non-FMLA)Page 2 of 4

and be selected for a position. If no positions are available or the Associate is not selected,employment will be terminated.5. If an Associate is requesting a PLOA for educational purposes, the PLOA may be extended upto one (1) year. However, only the Executive VP of HR or his/her selected designee canapprove this type of PLOA.6. For more detailed information contact the Leave Coordinator.VI.DOCUMENTATIONThe Associate is responsible to maintain current contact information and to notify CHN/CMG/CSGof any address or telephone number change.VII.REFERENCESCHN Continuation of Benefits PolicyCHN Extended Illness Bank PolicyCHN Family Medical Leave PolicyCHN Types of Workforce Relationships PolicyCMG Short Term Disability PolicyCSG Short Term Disability PolicyVIII. APPROVALSCommittee/Department OriginalApproval1 stReview2 ndReview3 rdReview4 thReview5 thReviewHuman Resources 03/28/00 10/1/03 4/13/07 3/04/08 12/22/08 09/09/11Legal 10/06/11Policy CoordinatingCommittee06/29/00 10/23/03 04/18/07 3/19/08 01/08/09 12/01/11Personal Leave of Absence (non-FMLA)Page 3 of 4

Request for Personal Leave ofAbsence (PLOA- Non-Medical)(Please Print- complete all sections)ASSOCIATE: PLEASE FILL OUT THIS SECTION, AND TAKE TO YOUR MANAGER/SUPERVISOR WHENCOMPLETED.Associate Name:DOH: EEID: Telephone No:Present address: (street) (city) (state) (zipcode)PLOA Effective Date:Expected Return Date:Reason for Leave of Absence:Supervisor:Ext.ASSOCIATEIF THIS LEAVE IS BEING REQUESTED FOR YOUR PERSONAL MEDICAL CONDITION, DO NOT COMPLETE THIS FORM.COMPLETE BOTH THE FAMILY MEDICAL LEAVE / EXTENDED ILLNESS BANK APPLICATIONS AND FORWARD THEM TO THEATTENTION OF “LEAVE COORDINATOR” - ASSOCIATE HEALTH & WELLNESS• You can request a personal leave of absence (PLOA) for a maximum of three (3) months once per rolling calendar year. The minimumtimeframe is 7 days.• You are responsible for submitting this completed request form to your Supervisor/Manager for approval.• This leave is NOT job protected.• You must use PTO during this leave.• Extended Illness Bank hours are not an option for payment during this leave and further EIB hours will not accrue during this leave.EIB hours will begin to accrue when you have returned to active work status.• Your current benefit elections will remain in effect during your PLOA. The associate premium will be deducted from available PTO. Ifyou do not have available PTO, you must contact the HR-Benefits Office to arrange self payment options. If you fail to assure all benefitpremiums are paid on a timely basis, your benefits will be subject to termination.• You must keep the Human Resources Department informed regarding your current mailing address and telephone numbers during thePLOA.• If you are unable/do not return to work upon the expiration of your leave, your employment and benefits will be terminated.• Prior to your return, you must contact your Supervisor/Manager to verify if your position is available. If your position was filled, youwill have 30 days to apply and be selected for a position. If no positions are available or you are not selected, your employment will beterminated.• Please note: a PLOA cannot be requested to secure another job opportunity.SUPERVISOR/MANAGER/HR GENERALIST• If the Manager/Supervisor and the HR Generalist agree to approve this leave, this completed and signed request form should be sent tothe HR Generalist with a completed Associate Action Form (AAF) .• The HR Generalist will determine whether there are outstanding contractual commitments where re-payment arrangements need to beestablished.• The Manager/Supervisor should secure all hospital property (including badge) prior to the PLOA effective date.• The Manager/Supervisor is responsible for completing the Associate Action Form (AAF) if/when the associate returns from PLOA.• For more detailed information, contact the CHN Leave Coordinator.I have read the above statements and wish to proceed with a PLOA Request.Associate Signature: ____________________________________________ Date: ____________________Manager Approval Signature: _____________________________________ Date: ____________________Completed and signed PLOA Request Form must be accompanied by a completed and signed Associate Action FormPersonal Leave of Absence (non-FMLA)Page 4 of 4