Employees who need to take absences of more than five working days for specified family and/or medical reasons may be eligible for unpaid, job-protected federal and state leave entitlements. It is an obligation under federal and state regulations, as your employer, for us to inform you of your eligibility and your rights and responsibilities under the federal Family and Medical Leave Act (FMLA) and the Wisconsin Family and Medical Leave Act (WFMLA). It is an obligation under federal regulations, as your employer, for us to designate WFMLA and/or FMLA leave if appropriate and it is a protection for employees if their leave would extend.
Under the federal Family and Medical Leave Act (FMLA), eligible employees have the right to take up to 12 weeks (480 hours/pro-rated for part-time employees) of unpaid, job-protected leave* for the following reasons:
- Birth of a child
- Placement with employee of a child for adoption or foster care
- Employee’s own serious health condition
- To care for a family member with a serious health condition
- A qualifying exigency for a military family member on covered active duty
- To care for a covered service member with a serious injury or illness
Under the Wisconsin Family and Medical Leave Act (WFMLA), eligible employees have the right to take unpaid, job-protected leave* for the following reasons:
- Up to 2 weeks (80 hours/pro-rated for part-time employees) for employee’s own serious health condition
- Up to 2 weeks (80 hours/pro-rated for part-time employees) to care for a family member with a serious health condition
- Up to 6 weeks (240 hours/pro-rated for part-time employees) for pre-birth bonding, birth of a child or adoption
*While leave designated under W/FMLA is unpaid, employees may substitute accrued paid leave (vacation, personal holiday, sick leave, ALRA, etc.) so they continue to receive pay while on leave. If you have questions about your leave balances, pay or benefits, contact your divisional Payroll & Benefits Coordinator.
Comparison of FMLA and WFMLA Laws
How to Request Leave
To request leave under W/FMLA, complete and return the required Medical Leave Forms directly to the FMLA Coordinator at 608-262-9515 (confidential fax) or firstname.lastname@example.org (confidential e-mail). As a designated Divisional Disability Representative (DDR), the FMLA Coordinator is responsible for maintaining confidential medical information for all SMPH employees. In order to make an informed decision about your leave request in a timely manner, submit the completed forms at least 30 days before the leave is expected to start.
All medical information is confidential (including leave request statuses and employee eligibility for FMLA) and can only be shared on a “need to know” basis. Access to confidential medical information is restricted. Only Divisional Disability Representatives (DDRs) are authorized to handle and retain medical information for employees.
If you have any questions or concerns about confidentiality, contact the FMLA Coordinator at 608-262-9515 (confidential fax) or email@example.com (confidential e-mail).
- Medical Leave Forms
- Military Family Leave Entitlements
- W/FMLA Leave Tracking Spreadsheets
- Related Policies
- Resources for Employees
- Resources for Supervisors
- Contact Information
|wdt_ID||Form||To be Completed by:||Additional Information|
|1||Medical Leave Request Form||Employee|
|2||Certification of Family & Medical Leave for Employee||Employee’s Treating Specialist||Not required for parental leave requests|
|3||Certification of Family & Medical Leave for Family Member||Family Member’s Treating Specialist||Not required for parental leave requests|
|4||Return to Work Authorization Form||Employee’s Treating Specialist||Required for employees returning from continuous leave for their own serious health conditions.
Due at least 2 business days prior to your expected return to work date. This is because we want to ensure that you are able to safely return to work and that we are in line with any restrictions set by your treating specialist.
As your employer, we reserve the right to send you home if you fail to provide a complete and sufficient Return to Work Authorization Form.
|wdt_ID||Form||To be Completed by:||Additional Information|
|5||Leave Without Pay or Temporary Assignment Request Form||Employee||Only required if you are planning to take leave without pay.
Complete and submit form to your supervisor and/or divisional HR Business Partner for approval.
Choosing to take leave without pay may affect your benefits, including health insurance and allocation of paid leave. We encourage you to contact the Office of Human Resources – Benefits Services at 608-262-5650 or firstname.lastname@example.org to discuss payment of premiums and any other questions related to your benefits and allocation of paid leave.
|6||UWMF Physician Parental Leave Request Form||Employee||Only required for employees affiliated with UWMF, in any capacity, who are requesting parental leave.
Complete and return the form directly to UWMF HR at email@example.com. For additional information, refer to the UWMF Physician Parental Leave of Absence Policy.
Eligible employees with a spouse, son, daughter, or parent on active duty or call to active duty status in the National Guard or Reserves in support of a contingency operation may use their 12-week leave entitlement to address certain qualifying exigencies. Qualifying exigencies may include attending certain military events, arranging for alternative childcare, addressing certain financial and legal arrangements, attending certain counseling sessions, and attending post-deployment reintegration briefings.
FMLA also includes a special leave entitlement that permits eligible employees to take up to 26 weeks of leave to care for a covered service member during a single 12-month period. A covered service member is a current member of the Armed Forces, including a member of the National Guard or Reserves, who has a serious injury or illness incurred in the line of duty on action duty that may render the service member medically unfit to perform his or her duties for which the service member is undergoing medical treatment, recuperation, or therapy; or is an outpatient status; or is on the temporary disability retired list.
- Certification of Qualifying Exigency for Military Family Leave
- Certification for Serious Injury or Illness of a Current Service Member
WFMLA does not have military-specific family leave provisions. However, caring for a service member/veteran may qualify as a WFMLA-eligible reason for leave.
Supervisors must maintain a leave tracking spreadsheet for each employee and for each approved W/FMLA leave the employee has. Once the leave ends, the supervisor must submit a copy of the leave tracking spreadsheet to the SMPH DDRs at firstname.lastname@example.org.
Under federal and state laws, SMPH Human Resources must maintain a record of all hours of W/FMLA leave taken by W/FMLA eligible employees for at least three years.
Employees should also maintain a leave tracking spreadsheet for each approved W/FMLA leave they have. Doing so will help the employee and supervisor resolve any leave usage discrepancies.
Leave Tracking Spreadsheets
SMPH FMLA Coordinator
If you have any questions about FMLA, contact the FMLA Coordinator at 608-262-9515 (confidential fax) or email@example.com (confidential e-mail).
SMPH Payroll & Benefits
For questions about your SMPH leave balances, pay or benefits, contact your SMPH Payroll & Benefits Coordinator.
Office of Human Resources – Benefits Services
If you plan to take leave without pay or utilize other benefits, such as Income Continuation Insurance (ICI), during your leave, we encourage you to contact the Office of Human Resources – Benefits Services at 608-262-5650 or firstname.lastname@example.org to discuss payment of premiums and any other questions related to your benefits and allocation of paid leave.
UWMF Human Resources
For SMPH employees affiliated with UWMF, contact UWMF HR at 608-263-6500 or email@example.com with any questions about the UWMF Physician Parental Leave of Absence Policy or your UWMF benefits. Contact your Department Administrator or their designee with any questions about your UWMF pay.