Whirlpool Leave of Absence Program. Provider Education Program

Transcription

1 Whirlpool Leave of Absence Program Provider Education Program

2 Program Objectives Partner with Medical Providers on FMLA/STD processes and how they can help: Streamline absence process for Whirlpool employees Help set patient expectations for STD/FMLA Improve Whirlpool employee productivity Ensure proper STD/FMLA certification 2

3 Topics to Address FMLA/LOA 101 Employee s Role Matrix Provider s Role Proper Leave Certification Intermittent Leave Planning Where to go for assistance/information Matrix Certification Process 3

4 Historical Information Effective January 1, 2010, selected Matrix Absence Services to manage and administer short-term and long-term disabilities, as well as Family Medical Leave for all locations across the U.S. Prior to this, Whirlpool had 63 various plans across the U.S. administered by three separate vendors as well as selfadministration. Effective January 1, we were able to reduce from 63 to 5 plans with one administrator. Compliance Consistency Effectiveness 4

5 Whirlpool Leave of Absence Program Provides time off for Whirlpool employees who need to care for their own or a family member s medical condition, or For other qualifying Family Medical Leave reasons examples such as call to active military duty, or care for injured military family member 5

6 Starting January 1, 2010 Matrix Processes all new Whirlpool STD/FMLA requests Processes all Leave extensions, New: Initiate medical certifications directly with providers New: Track employee s time off against approved Leave parameters and address out-of-bounds leave absences with employees require additional certifications or appropriately deny Leave protection New: manage a proactive Return-to-Work process 6

7 Streamlined Process Employee contacts Matrix intake center by calling (24/7) to initiate a short-term disability, Family Medical Leave or report an intermittent absence related to a certified FML. Information is processed and assigned to a Matrix Leave Specialist. Within 1 business day from intake, Matrix contacts employee s healthcare provider, either telephonically or by fax, to obtain certification. Three attempts will be made over 10-day period. (Matrix notifies employee and Whirlpool contact if certification is not received by 10 th day) 7

8 Process cont d If certification is not received by 15 th day, following FML guidelines, claim may be closed. Denial notices are sent to Employee and Whirlpool Because of the denial, division policies are followed related to absences, which may include: Attendance points Disciplinary actions Once medical certification is received from the medical provider within the 15-day period: Matrix Leave Specialist reviews claim Nurse case manager may review for duration of disability following medically based-guidelines Interaction may be required with the physician office to obtain additional information Approval notices are sent to Employee and Whirlpool 8

9 Process cont d During the employee s leave, s/he is assigned a specific Absence Management Specialist. This Absence Management Specialist is the primary contact for both the medical provider and employee should there be questions related to this disability or Family Medical Leave Matrix office is located in Phoenix AZ. Office hours are 9 a.m. to 7 p.m. EDT to reach Absence Management Specialists, Supervisors or Managers Whirlpool dedicated fax number 9

10 Six Serious Health Conditions Inpatient care plus ensuing incapacity and treatment More than 3 days incapacity plus treatment Colds, flu, common headaches, and other common ailments can become SHC Pregnancy-prenatal care Chronic condition Permanent & long-term conditions Multiple treatments 10

11 Care of Family Member Family member must be unable to care for basic medical, hygiene, or nutritional needs or safety Family member is unable to transport him/herself to a physician Employee is needed to provide comfort to family member with a serious health condition and receiving inpatient or home care 11

12 Definition of Family Member Spouse Husband or wife as defined by state law including common law marriages. Federal FMLA does not include same sex partners. Parent Biological parent or individual who stands or stood in loco parentis to employee. Federal FMLA does not include parents-in-law. Child Biological, adopted, foster, stepchild, legal ward, or child of person standing in loco parentis. Must be under 18 unless incapable of self-care due to disability 12

13 Certification of Serious Health Condition Whirlpool follows the federal guidelines contained within the Family Medical Leave legislation: Certification from health care provider may be required and must be submitted within 15 days of request Certification must state that employee: is unable to perform job functions is needed to care for a child, spouse, or parent and estimate of time needed for their care 13

14 Information Gathered: Employee s Serious Health Condition (SHC) Identity of health care provider Certification of employee s SHC Medical facts supporting certification Date condition commenced and probable duration For pregnancy-related and chronic conditions, duration and frequency of incapacity 14

15 Information Gathered: Family Member s Serious Health Condition (SHC) Whether family member requires assistance with basic medical or personal needs, safety, or transportation Whether employee s presence is needed to provide psychological comfort Whether need for employee is intermittent/reduced and duration of leave 15

16 Medical Re-certification May be requested no more often than: every 30 days, or minimum duration of original certification, if longer than 30 days, or circumstances have changed significantly, or information is received that casts doubt on reason for absence 17

17 General Actions of Employee and Employer Employee: Employee provides notice of need for family/medical leave of absence to Matrix. Submits signed release for Medical Information. Contacts Employer and Matrix with leave status updates, as appropriate. Physician: Responds promptly to contact from Matrix for medical certification of the employee s absence Provides complete information as required by the type of benefits the employee has requested 18

18 Return to Work Matrix call to employee five days prior to scheduled release Reminder of Whirlpool specific RTW policies such as: Required RTW note from doctor Mandatory drug testing requirement Check in with Supervisor/Manager Return to work ecomm to Whirlpool confirming actual return-to-work date Day of RTW contact to employee and/or supervisor to confirm employee has returned to work 19

19 Key Matrix Contacts for Medical Providers Claims & Questions: 800/ FAX: 877/