Health Insurance Coverage & Pregnancy-Related Disability

Authors: Li-An C. Leonard and Anne K. Wilson

Effective January 1, 2012, California Government Code section 12945 requires employers with five or more employees to maintain health insurance coverage, while an employee is on a pregnancy-related disability leave, at the same level and under the conditions that such coverage would have been provided if the employee had continued active employment. Such coverage must be maintained for the duration of the pregnancy-related disability leave, but not to exceed four months in a 12-month period.

Employers may recover health insurance premiums from the employee if the employee fails to return to work after the pregnancy-related disability leave expires and such failure is not (a) because the employee has taken leave separately under the California Family Rights Act (CFRA), (b) for a health condition that entitles the employee to leave under applicable law, or (c) for other circumstances beyond the employee's control.

How This New Law May Affect You

  • Employers with five to 49 employees will notice the biggest impact from this new law. Prior to the enactment of California Government Code section 12945, these employers were not required to maintain health insurance coverage for employees on a pregnancy-related disability leave because they were not subject to the Family and Medical Leave Act (FMLA) requirements. However, as of January 1, 2012, they are now required to continue to maintain health insurance coverage for those employees who take pregnancy-related disability leave.
  • Employers with at least 50 employees are already required to maintain health insurance coverage under the FMLA for eligible employees on a pregnancy-related disability leave. However, unlike the FMLA, California Government Code section 12945 does not require an employee to have worked for the employer for at least one year and at least 1250 hours in the past 12 months to be eligible for continued health insurance coverage. Under this new statute, even recently-hired employees will be entitled to have their health insurance coverage maintained during a pregnancy-related disability leave.

We recommend you consult with your health benefits plan administrator to ensure your plan conforms to California Government Code section 12945.

Additionally, HR and payroll administrators should revise their existing employment policies and leave forms to comply with California Government Code section 12945. New-hire training materials and employee handbooks may also need to be updated.



California Employment Law Update is a publication of Duckor Spradling Metzger & Wynne's Employment Law Group.
The information contained in this publication is not intended to be and should not be construed as legal advice or opinions. Such advice and opinions are provided by the firm only upon engagement with respect to specific factual situations.
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