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Enrolling a Member in FMLA
Employee on leave and subject to Family Medical Leave Act (FMLA)
Use FMLA Leave Request Form. Be sure to indicate if the employee contributes to any benefits, the paid through
date of the benefits and the payroll frequency (i.e., weekly, bi-weekly). A confirmation will be emailed to the
employer confirming receipt.
Click here for the FMLA enrollment form.
*COBRA, HIPAA and FMLA administration is provided by COBRA Administration and Health Services, Inc. (CAHS) under the Choice COBRA brand name. The service contract for these services is between the employer and CAHS.
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