SPD: Family & Medical Leave

General Eligibility and Forms

US Department of Labor’s Notice to Employees of Rights under the FMLA - This document is required by the US Department of Labor (DOL) to be provided to employees of covered employers. The State of Indiana is a covered employer.

Eligible employees have:

Worked for the State for 12 months
Worked 1250 hours in the 12 months immediately preceding the need for leave
Not exhausted entitlement to Family Medical Leave (FML) in the current fiscal year (July 1 – June 30)

Leave may be taken for the following qualifying events:

Birth of employee’s child.
Placement of a child with employee for adoption or foster care.
For the care of employee’s spouse, child or parent who has a serious health condition.
The serious health condition of the employee which prevents the employee from performing the essential functions of his/her job.
Because of a qualifying exigency arising out of the fact that the employee’s spouse, child or parent is on covered active duty or call to covered active-duty status.
For the care of a covered servicemember with a serious injury or illness.

FML Basics provides additional information about FMLA leaves.

FMLA Leave Certification Forms

Upload forms in the Indiana State Employee Portal or Fax FML forms securely: 317-974-2029.

Approvals to use FML intermittently due to long-term or chronic conditions expire each fiscal year on June 30. New requests and new certification forms must be submitted prior to July 1 to obtain approval for FML absences in the next fiscal year. Unused FML does not carry over to a new fiscal year.

Forms and Additional Information
For serious health conditions and pregnancy/childbirth recovery:
For leave for parenting your newborn or adopting or providing foster care to a child(ren):
- Documentation about the facts and time frames of the birth of your biological child you wish to spend time getting to know or activities related to adopting or becoming a foster parent to a child(ren) and time spent helping your newly-adopted or newly-placed foster child(ren) with adjustments and transitions. This leave is available only during the first year after the birth, adoption, or placement of the child(ren).
For a qualifying exigency related to military deployment of your spouse, child, or parent:
- Certification of Qualifying Exigency for Military Family Leave
It is your responsibility to ensure the Certification of Health Care Provider forms are filled out completely by the appropriate person and include description/details of medical necessity for and the estimated frequency and duration of absences for which you are requesting leave. Timely submission of the Certification of Health Care Provider form is YOUR responsibility, not your health care provider's.
Second and third opinions may be required. The State has the right to confirm that the Certification is authentic and may contact a health care provider to do so.
If Certification is not complete or contains illegible, ambiguous, contradictory, or vague answers, you may be required to get the health care provider to clarify the document. There is a 7-day time limit for clarification, and your request cannot be approved without submission of a properly completed Certification.

Disability Forms

Full-time employees become eligible for the State’s Short- and Long-Term Disability Plan after completing six consecutive months of active service (without a break in service or an unpaid leave of more than two weeks).

If an eligible employee is pregnant or there is a chance that a leave for the employee's own serious health condition may last more than 30 consecutive calendar days, then the employee must apply for the state's Short/Long Term Disability (S/LTD) Plan by completing and submitting these forms to the address/fax listed on the forms as soon as the need for leave becomes known. This is a separate process and must be completed in addition to the FML process in appropriate situations.

Application for S/LTD Benefits
Employee completes these forms:
Doctor completes this form:
- Attending Physician's Statement
Information about submitting a claim and the State’s Short/Long Term Disability Plan are located at these two links:
- Instructions for Submission of a Disability Claim
- Short- and Long-Term Disability Program Employee Handbook
JWF Specialty Company
- Phone: 1-888-818-7795 (toll free), 317-574-7876 (local)
- Fax: 1-866-893-4674
- Online Application Forms: www.jwfspecialty.com/applications-forms
- Mailing Address: P.O. Box 40968, Indianapolis, IN 46240
FML will be charged concurrently with State’s Short- and Long-Term Disability Plan and New Parent Leave for eligible employees.

Applying for Family-Medical Leave in PeopleSoft^®

Direct Process through the Indiana State Employee Portal is required for all FML requests.

Requests and supporting documentation are accessible only by Absence Administrators: Indiana State Personnel Department’s centralized FML-processing staff and designated HR representatives in non-centralized organizations such as legislative or judicial branch entities and elected officials.

Employees
Only Employees or Absence Administrators can initiate FML requests for approval or usage of approved leave.
Initiate a Request for Approval
- From the Employee Self-Service Homepage, select the Time Tile > Extended Absence Request Tile > Select the Plus Sign (+) > Select Family and Medical Leave Act as the Absence Type and FML – Initiate Request as the Absence Take and then Launch.
- Follow the steps to complete all the fields, attach your documentation, and submit your request.
Request to Use Hours of Approved FML on Specific Date(s)
- From the Employee Self-Service Homepage, select the Time Tile > Extended Absence Request Tile > From the list, select the applicable FML request > Select the FMLA Details link and note the FMLA Request ID number > Select the Add Absence button > Select the appropriate Absence Name from the drop-down list > Enter the Start Date and End Date.
- If using hours different than what is shown in the Duration field, select the Partial Days row to enter hours and select Done.
- Enter the FMLA Request ID you found above in the FMLA Details link and select the Check Eligibility button. If Completed Successfully, select OK and select the Submit button. Select Yes to confirm the submission and OK. Review status to ensure it updated to Approved.
- Select X to close the window and return to your home page.
- Log into the State of Indiana's Jam platform, powered by SuccessFactors
- If absence is concurrent with Disability benefits period, DO NOT enter leave on your timesheet. Information for time spent on Disability is entered by JWF on an interface.
Managers
Managers DO NOT have access to enter FML or NPL requests on behalf of employees. In situations where it is impossible for an employee to submit an extended absence request for an unexpected need occurring in the current pay period, a manager must follow these procedures to contact an Absence Administrator for assistance:
- Manager Request on Employee’s Behalf for Usage of Family & Medical Leave or New Parent Leave must be completed and submitted to an Absence Administrator for initial and subsequent usage requests on behalf of employees. INSPD Employee Relations Fax Number is 317-974-2029.
- HR staff in centralized agencies must also use the manager request form above to submit initial or subsequent usage requests on behalf of employees.
Expectant Parents
EXPECTANT PARENTS should also review the Expectant Parent Packet and visit INSPD's New Parent Leave webpage.
- Explanation of the overlap among FML, Disability Plan, and NPL and guidance for preparing and planning leave related to the arrival of your child.
- Full-time employees who have completed six (6) consecutive (without a break in service) months or more employment in a permanent position in state service at the time their child is born or adopted are eligible for up to 150 hours of paid leave (75 hours for part-time employees) of New Parent Leave (NPL).
Deadlines and Consequences
- Requests/Applications for FML must be submitted no later than the same or next business day after learning of the need for leave. If the need is foreseeable more than 30 days in advance (such as a surgery or childbirth), the request must be submitted in advance of the first anticipated day of leave.
  - These deadlines apply to both an initial request for FML approval and subsequent requests to use hours of approved FML.
  - Employees are obligated to schedule appointments and treatments whenever possible on dates and times that minimize disruptions to operations.
- Employees have 15 calendar days to submit supporting documentation (usually an FML Certification Form linked above). Failure to upload/fax the documentation or call and request a formal extension within that time will result in automatic denial of the request.
- If the submitted documentation is not complete or contains illegible, ambiguous, contradictory, or vague answers, employee may be required to get the health care provider to clarify the document. There is a 7-calendar day time limit for clarification, and the request cannot be approved without submission of clear, complete documentation.
  - Failure to upload/fax the documentation or call and request a formal extension within that time will result in automatic denial of the request.
  - The State has the right to confirm that the documentation is authentic and may contact a health care provider to do so.
- The State has 5 business days after receiving all the relevant documentation to respond to the request - absences taken prior to receiving that response may be unauthorized and subject to disciplinary action unless the absence(s) would otherwise be covered by other approved leave. If the approval covers previous absences, any unauthorized leave or disciplinary action for covered absences must be removed.
- Agency policies for reporting absences apply to FML. Barring extenuating circumstances, if an absence is unforeseeable or taken in the form of intermittent leave, you must comply with agency leave/call-in procedures and time limits, 15 minutes before the shift or 1 hour before the shift in 24-hour operations, for each day of absence. Failure to meet these time limits may result in disciplinary action for any/all days for which procedures are not followed.
Additional Resources
- Sometimes an FMLA-qualifying serious health condition is also a disability, and employees may want to request reasonable accommodations that would enable them to perform the essential functions of their jobs and perhaps reduce the frequency, duration, or intensity of flare-ups of the employee’s condition. See www.in.gov/spd/policies-and-procedures/americans-with-disabilities-act.
- Situations requiring FMLA leave may also create stress or a need for other services.
  - The Optum Employee Assistance Program is available by phone 800-886-9747 (24/7 support), or online at liveandworkwell.com (access code: Indiana).
  - Review your INSPD Benefits Plans to determine coverage and find the most cost-effective providers for your needs.
  - If you are caring for a family member, you may be eligible for services provided by the Family & Social Services Administration.
  - If you are caring for a military servicemember, the Indiana Department of Veterans Affairs may be of assistance.
Portal Steps
At the Indiana State Employee Portal these paths will take you to screens for entering your requests to use hours of approved FML, viewing existing requests and remaining balances for yourself (ESS) or your direct reports (MSS):
- Extended Absence Request
  - Employee Self Service (ESS) > Time tile > Extended Absence Request tile
- View Absence Balances
  - Employee Self Service (ESS) > Time tile > Absence Balances tile
  - Manager Self Service (MSS) > Team Time tile > Absence Balances
- View Absence Requests
  - Employee Self Service (ESS) > Time tile > View Requests tile
  - Manager Self Service (MSS) > Team Time tile > View Requests

Family & Medical Leave

General Eligibility and Forms

Disability Forms

Applying for Family-Medical Leave in PeopleSoft®

Applying for Family-Medical Leave in PeopleSoft^®