One of the biggest worries about going to treatment is losing your job. For many New York State and government employees, the federal Family and Medical Leave Act (FMLA) can provide job-protected leave to get care. This guide explains the basics of how FMLA can apply to addiction treatment and how it fits with NYSHIP coverage. This is general education, not legal or medical advice — please confirm the details with your HR office, your union and, if needed, a qualified attorney.
FMLA is a federal law administered by the U.S. Department of Labor. According to the Department of Labor, eligible employees of covered employers can take up to 12 weeks of unpaid, job-protected leave in a 12-month period for certain family and medical reasons, with continuation of group health benefits during the leave.
The Department of Labor's FMLA fact sheet explains that to be eligible you generally must have worked for your employer for at least 12 months, logged at least 1,250 hours in the prior 12 months, and work at a location with at least 50 employees within 75 miles. Many public agencies are covered employers.
FMLA leave can be used for treatment of a "serious health condition." The Department of Labor's regulations state that substance abuse may be a serious health condition when the conditions are met, and that FMLA leave may be taken for treatment of substance abuse provided by a health care provider. Two important points to understand:
Because these rules can be nuanced, it is wise to talk with your HR department and union representative before you request leave, and to keep documentation of your communications.
While each employer's process differs, the general steps usually look like this:
Your privacy is protected during this process. The Department of Labor's employer guide notes that medical information provided for FMLA must be kept confidential, and treatment records may also be protected under federal substance use privacy rules.
FMLA leave does not always have to be taken in one block. Depending on your situation and your provider's certification, leave may be continuous — for example, several weeks in a residential program — or intermittent, taken in smaller increments to attend ongoing outpatient appointments. Intermittent leave can be useful for people stepping down from inpatient care to an intensive outpatient schedule while returning to work. Your employer may ask for certification supporting the need for the schedule you request, so coordinating with your provider and HR helps the process go smoothly.
FMLA is one piece of a larger picture. Depending on your situation, you may also have rights under state leave laws, your collective bargaining agreement, or disability accommodation laws. Public employees in New York often have union representation that can help you understand your full set of options and advocate on your behalf. Because these protections interact in ways that depend on your specific employer and circumstances, it is worth asking your union and HR which apply to you before you make decisions.
During approved FMLA leave, your employer generally must maintain your group health coverage on the same terms as if you were working. For NYSHIP members, that typically means your Empire Plan coverage can continue while you are in treatment. Confirm the specifics with your HR or benefits office, and ask how any premium contributions are handled while you are on leave.
FMLA protects your job; NYSHIP and the Empire Plan help pay for care. The two work together: leave gives you the time, and your insurance helps cover detox, inpatient or outpatient treatment, subject to your plan, network and medical necessity. To understand your benefits, see our does NYSHIP cover rehab page or start a NYSHIP coverage verification with us.
Taking time to get well is a responsible decision, and the law offers protections to help you do it. For free, confidential, 24/7 support, contact the SAMHSA National Helpline at 1-800-662-4357. If you are in crisis or having thoughts of suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline. To discuss treatment options and how NYSHIP coverage can help, call us at 213-321-6518.
We confirm your exact NYSHIP / Empire Plan coverage and report back, usually within a few hours. HIPAA & 42 CFR Part 2 protected.
Call 213-321-6518