Answers when you have questions.
Guidance when you need support.
SM
Are you facing one of the following?
Birth of a child
Care for an injured
service member
Care for your own
serious health condition
FMLASource ® provides employees with quick
access to experts who will answer questions,
review guidelines and provide information regarding
a job protected medical or family leave of absence.
Please contact FMLASource for information and
forms required for your leave.
Adoption or foster care
Care for a child, spouse or parent
with serious health conditions
Call: 877.462.3652
TDD: 800.697.0353
Fax: 877.309.0218
Online: fmlasource.com
FMLASource ® Inc. is a ComPsych ® company.
Copyright © 2011 ComPsych Corporation. All rights reserved.
Announcing Family and Medical Leaves of Absence Now Administered by FMLASource
Effective Date: January 1, 2016 - We are pleased to announce that the Family and Medical Leave Act
and the Wisconsin Family and Medical Leave Act are now being administered by FMLASource on behalf of
Portage County. This service will ensure that your leave is properly and efficiently handled and that qualifying
claims are filed.
Family and Medical Leave Act of 1993
FMLA provides up to 12 weeks of unpaid, job protected leave to “eligible” employees for certain family and medical
reasons. You are eligible if you have worked for Portage County for at least 12 months and worked for 1,250 hours
over the previous 12 months.
■
Reasons for Taking Leave
Unpaid leave must be granted for any of the following reasons:
 To care for your child after birth, or placement for adoption or foster care
 To care for your spouse, son, daughter or parent who has a serious health condition
 For a serious health condition that makes you unable to perform your job
 In situations of qualifying exigency to be with an employee’s spouse, parent or child if said person is an active
service member or has an impending call to active duty in support of a contingency operation
 For the care of an injured service member if the service member is the employee’s spouse, child, parent, or
“next of kin.” FMLA taken for this reason includes an entitlement of up to 26 weeks in a 12-month period.
■
Advance Notice and Medical Certification
You may be required to provide advance notice and medical certification. Taking leave may be denied if
requirements are not met:


■
You ordinarily must provide 30 days advance notice when the leave is foreseeable.
Portage County may require medical certification to support a request for leave because of a serious health
condition, and may require second or third opinions (at the employer’s expense) and a fitness-for-duty report to
return to work.
Job Benefits and Protection
 For the duration of FMLA leave, Portage County must maintain your health coverage under any “group health
plan.” You will continue to be responsible for your portion of the cost sharing of the premium payments.
 Upon return from FMLA leave, employees must be restored to their original or equivalent positions with
equivalent pay, benefits and other employment terms.
 The use of FMLA leave cannot result in the loss of any employment benefit that accrued prior to the start of an
employee’s leave.
What You Should Do
■
Any time you are missing work due to your own serious medical condition or the care of a family member’s
condition, please contact FMLASource.




Contact your Supervisor or Human Resources Representative.
Call 1.877.GO2.FMLA (1.877.462.3652) or log on to www.fmlasource.com.
Your information will be verified by a Benefits Specialist who will initiate the leave of absence process and
answer any questions you may have.
You will be notified of the status of your FMLA claim once it has been processed.
FMLA Checklist
Portage County
877.462.FMLA
 Contact FMLASource to notify of need for leave via:
Website: www.FMLASource.com
Phone: 1.877.462.FMLA (1.877.462.3652)
Fax: 1.877.309.0218 (initial request form)
E-mail: [email protected]
 Receive Medical Certification form (2 page form) from
FMLASource or downloaded from the Internet
 Take Medical Certification form to physician for completion
 Verify physician completed Medical Certification form
 Verify FMLASource received correctly completed Medical
Certification form directly from physician
 Receive FMLA decision letter from FMLASource
 If approved for leave:
 Intermittently—contact your manager and FMLASource to
report FMLA hours used
 Continuously—contact your manager and FMLASource to
report your return to work date
 If denied for leave:
 Contact FMLASource
FMLASource  455 N. Cityfront Plaza Drive, Chicago, IL 60611-5322
Phone: 1-877-462-FMLA  Fax: 1-877-309-0218
www.FMLASource.com  [email protected]
,95*XLGH)0/$
7KHHPSOR\HHZLOOILUVWKHDU
“Thank you for calling FMLASource®. Please have your employee ID and claim number available before continuing
as you will be required to enter these numbers. If these numbers are not available, your call will be answered by an
FMLA representative during business hours.”
)LUVW/LVWRI2SWLRQV
! Thank you for calling FMLA Source.
! For English press 1, for Spanish press 2.
6HFRQG/LVWRI2SWLRQV
! For inquiries or to report time on an existing leave request, press 1.
! By pressing #1, the employee will be able to enter and extract information on their leave using our
automated phone system.
! For all other inquiries press 2
,I\RXSUHVVHG\RXZLOOKHDU
! To enter your leave request number, press 1.
! To enter your employee ID, press 2.
! By pressing #1 or #2, the employee will be
asked to enter their home zip code per the
client’s eligibility file. Once entered, they will
have access to the following automated
options:
! #1 Report Time
! #2 Check Available FMLA Time
! #3 Leave Status
! #4 Reporting a Return to Work Date
! #5 Fax and Mailing Information
! #0 To speak to a specialist
,I\RXSUHVVHG\RXZLOOKHDU
! For our fax and mailing address, press 1.
You will receive the following message:
Please remember that all medical certifications faxed to
us must be faxed directly from the doctor’s office. Our
confidential fax numbers are 877.309.0217 or
877.309.0218. Our address is the FMLA Center at 455
N. CityFront Plaza Dr, 10th Floor, Chicago, IL 60611.
You may visit our website at www.FMLASource.com to
view your current FMLA status or request a new FMLA
leave. You may also contact us via e-mail at
[email protected] with any questions
you may have about your FMLA request. Thank you for
calling FMLASource.
‹&RP3V\FK&RUSRUDWLRQ$OOULJKWVUHVHUYHG
! To leave a message, press 2.
You will receive a message to leave the following
information
! Leave name
! Phone # (with area code)
! Employee ID
! Date(s) FMLA used
! Number of hours used
! Date return to work
! FMLASource voice mails are checked daily
! If you wish to speak to a representative,
e-mail [email protected]
! To report issues with the FMLAsource
website press 3.
Connects with live rep, unless after hours, then
the same information will be requested as option 2
! To open a new leave request, press 4.
Connects with live specialist, unless after hours,
then the same information will be requested as
option 2
! For a representative, press 0 (zero).
Connects with live rep, unless after hours, then
the same information will be requested as option 2
To return to the main menu, press 9.
N E W ! Report Your Leave-Related Absences Online
FAST
›
EASY
›
ACCURATE ›
AVAILABLE 24/7
Managing intermittent leave is faster and easier than ever! Now you can report leave-related intermittent
absences such as doctor appointments online 24 hours a day, 7 days a week. A scheduled absence can be
reported in advance, or on the day it occurs. If you prefer, you can still call in to report time missed as well.
Reporting Absences is Easy
Just log in to our Web site and click on Check Status. Choose the leave you want to report and select Report
Time. Enter the date and time of your planned absence and click the Confirm button. That’s all there is to it!
Your Source for Information
Call or go online for expert answers to your questions about leaves of absence.
Call: 877.462.3652
Fax: 877.309.0218
FMLASource Inc. is a ComPsych company.
Copyright © 2011 ComPsych Corporation. All rights reserved.
®
®
TDD: 800.697.0353
Online: fmlasource.com