When absence is foreseeable, provide your supervisor with 30 days’ notice before taking a medical leave of absence under FMLA/CFRA. Foreseeable leaves of absence include pre-scheduled surgery and time off for child birth, and/or to bond with a new child. Complete the Request for Family and Medical Leave form. Should you need a leave of absence suddenly to care for yourself or a family member, you must notify your supervisor or HR as soon as practicable.

The FMLA/CFRA Medical Certification Form must certify that the absence is required for a ‘serious health condition’ of the employee or the employee’s family member.

It must include:

• Start date of the condition
• The expected duration of absence
• The anticipated return to work date
• Signature of the health care provider

The certification must not include diagnosis, but must detail the required time away from work. The medical certification is private and confidential and should be submitted directly to Human Resources Department, within 15 days of your request for leave.

Intermittent leave may be taken as the condition requires. However, the treating practitioner must provide specific information regarding frequency and duration of intermittent leave. If leave is for medical appointments, specific dates and times must be provided by the healthcare practitioner.

You will receive from Human Resources a notice of approval, provisional approval, or denial via US mail within a few days after they have received the medical certification from you. The letter will include contact information for you to call or email with any questions or concerns about your leave of absence.

While FMLA, CFRA and PDL provide job-protection and maintenance of benefits to eligible employees, the protected time off is unpaid. Therefore you must use your own leave accruals while on an FMLA/CFRA or PDL and, if eligible, integrate supplemental income such as State Disability Insurance (SDI) and/or Paid Family Leave (PFL).  Both SDI and PFL are administered by the State of California Employment Development Department (EDD).

Participation in SDI/PFL is determined by bargaining unit and is an employee-paid benefit.  Currently, only members of SEIU, SEIU-Child Care, WCE and PEU Local 1 Confidential contribute to SDI.   However, employees who do not contribute through their City employment may have SDI “credit” based on any employment prior to or outside of your employment with the City of San Rafael.

During the time you are on FMLA/CFRA or PDL, the City-paid portion of health (flex dollar contribution) and other benefits (dental, vision, life, LTD) will continue and any employee portion will be deducted from your paycheck. If you run out of accrued paid time off while on any protected leave, you will be placed on Leave Without Pay, during which time you will continue to receive the City’s contribution towards your benefits and must make a payment arrangement with Human Resources to pay directly for the balance due for any employee portion of your premiums.

Unpaid Leave of Absence After Protected FMLA/CFRA or PDL

There are times when employees must remain on unpaid medical leave beyond protected FMLA/CFRA. In this case, in order to maintain your benefits coverage, you must pay the full premium contributions for yourself and any enrolled dependents. Payments are made directly to Human Resources. It is your responsibility to work with HR to make a payment arrangement or make temporary changes to your benefits enrollment. Failure to make timely premium payments can result in the termination of your benefits, which may not be reinstated until you return to work or during Open Enrollment.

1. The most important part of your responsibilities while on leave is to remain in communication with your department, particularly if there is a foreseeable change to your return date whether you plan to return sooner or later than first expected.
2. If there is an extension to your return date send in the appropriate Medical Certification Form before your original expected return date arrives, preferably a week or two before so that your department can further plan for coverage of your usual duties.
3. If you apply for and receive SDI/PFL, contact Payroll immediately at (415) 485-3453 to integrate funds with your paycheck by coordinating buy back of leave accruals used while on FMLA/CFRA or PDL protected status.