FMLA Repayment of Health Care Premiums Letter

Re: Repayment of health care insurance premiums after FMLA Leave*

Dear [Employee name]:

You were on an extended period of leave of absence from [Company Name] during the period [dates]. For the duration of this leave, the company continued your insurance coverage and paid premiums in the amount of $ [amount]** based on your advising us that you would be returning to work at the end of your leave. As you have now advised us that you will not be returning to your position, this letter serves to request reimbursement for health care premium costs we incurred during your leave of absence to maintain the coverage.

You may elect to pay the required amount in one lump sum payment within 10 days of the date of this letter or by paying in three equal installments of $[amount] over a 60-day period with the first payment due within 10 days of the date of this letter.

If we do not hear from you with your decision of an election of a repayment option within 14 days of the date of this letter, it will be necessary for us to begin proceedings to compel you to repay the debt owed to the company.

*Note: Repayment letters should only be used with employees who fail to return to work following FMLA leaves in circumstances permitted under 29 CFR 212(b) and 29 CFR 825.213.

**The amount shown is the total cost of coverage, net of received employee contributions, incurred by the company during this period of FMLA absence.