FMLA & LWOP Premiums Due

Access premium notices and forms for Family Medical Leave Act (FMLA) and Leave Without Pay (LWOP) situations.

Administrative Guide

PDF Document July 2024

Policies and procedures for administering benefits, including FMLA and LWOP premium payments.

Critical notices regarding premium payments and benefit termination.

PDF Document December 2024

Important notice regarding benefit termination for non-payment of premiums.

PDF Document Current

Form for submitting self-pay premium payments during FMLA or LWOP.

Premium due notices for Family Medical Leave Act situations.

PDF Document December 2024

Initial premium due notice for FMLA leave situations.

PDF Document December 2024

Second reminder notice for FMLA premium payments.

PDF Document Current

Final notice for FMLA premium payments before termination.

Premium due notices for Leave Without Pay situations.

PDF Document Current

Initial premium due notice for LWOP situations.

PDF Document December 2024

Second reminder notice for LWOP premium payments.

PDF Document Current

Final notice for LWOP premium payments before termination.