1. FMLA - the Family and Medical Leave Act of 1993 provides certain employees with a maximum of 12 weeks of unpaid leave per year for the purposes of care for self, spouse, child, or the birth of a child. Employees become eligible for FMLA when they have worked for their employer for at least 12 months and at least 1,250 hours during the past 12 months. FMLA applies to all public agencies, all public/private elementary and secondary schools, and companies that employ 50 or more people in a 75-mile radius. During this 12-week period, the employee's health benefits must be maintained, and the employee's position must be held (the employer is permitted to hire temporary help to fill the position). Beyond 12 weeks, the employer is not required to provide health care benefits, however, COBRA must be offered.

The most common FMLA issues facing case managers are due to time out of work on worker's compensation being included in the 12-week period if the employer notifies the employee in writing; thus, if the employee is out for longer than 12 weeks on worker's compensation, the employer does not have to continue healthcare benefits or hold employee's position.

2. COBRA - the Consolidated Omnibus Budget Reconciliation Act of 1986 requires employers to offer terminated employees healthcare coverage for 18 months. The employee must pay for the insurance but may purchase the insurance at the employer's group rate.

3. ERISA - the Employee Retirement Income Security Act of 1974 exempts self-insuring non-government employers from more costly state insurance mandates for coverage.

4. TEFRA - the Tax Equity and Fiscal Responsibility Act of 1982 requires employers to offer equal health insurance benefits to all their employees, including those over the age of 65 who are eligible for Medicare. Additionally, TEFRA mandates that, in the case of such an employee, the private insurance plan will serve as primary payor and Medicare as the secondary payor.

5. OBRA - the Omnibus Budget Reconciliation Act of 1986 established private employee-sponsored as primary payor and Medicare as secondary payer for individuals covered under both SSDI and a spouse's health plan, and those who returned to work.