Need to Know on Offering Benefits to Employees Who Aren't 'Actively At Work', Sep. 30, 2021

Many employers continued to allow employees to participate in employee benefit programs while the employee was not actually working during the COVID-19 pandemic. While many employees have now returned to work, in some areas rolling shutdowns may continue to impact the employer's ability to retain employees on a continuous basis. It can be risky to allow employees to remain on an employer's health insurance benefit plan while not actively at work. In many cases, fully insured plans have "actively at work" clauses that apply in determining the employee's eligibility for benefits. Employees typically can continue to participate for up to three months after ceasing work (to comply with FMLA time limits). For employers with self-insured health plans, stop loss coverage may not apply to cover claims if the employee is not actively working. Small business clients should check their plans and establish a policy on how employees who are not actively at work will be treated for benefit purposes. For more information on self-insured plans, see Q 8808.