An employee who leaves employment due to illness, accident, additional schooling or family needs may be eligible for a leave with benefits. 


The leave of absence would begin after 12 weeks of FMLA leave and may not exceed six months.  

The Leave of Absence must be approved by the pastor, administrator, and/or board of the parish.  It must be documented in writing and signed by the employee and supervisor.  A copy must be sent to the Archdiocese Human Resources Office to be covered by Archdiocese benefits.  The original signed document is to remain at your location in a file that is separate from the employee’s normal personnel file per Federal regulations.  

During the first 12 weeks/FMLA Leave: the employee is responsible for their portion of benefit premiums as usual.  

Beginning week 13/Leave of Absence: the employee is responsible for 100% of their benefit premiums (employee portion & employer portion). Maximum is 6 month Leave of Absence.
Please contact Maura Dodson for assistance in determining specific premium totals: 913-647-0362
Payments from employees can be made via personal check made out to your location as premium prepayments or the premium can be taken out of  the employee’s pay before disability or accumulated personal leave during disability, (required if benefits are pretax).  



If the employee makes a written request for leave which is approved under the Federal Family and Medical Leave Act, the employee’s health and dental benefits are paid according to their current rate or policy schedule during the requested family leave which may not exceed twelve weeks.  For the authorized leave beyond the FMLA 12 weeks, the benefits are paid as explained above. 

FEDERAL LAW requires FMLA paperwork be completed by the employee and health care provider.  FMLA forms are at the bottom of this page. Completed forms are required to be filed in a file separate and away from the employee’s personnel file. Do not count holidays or breaks, during disability, as FMLA leave time.

Service credit for the Retirement Plan is accrued during a leave of absence not to exceed six months. Be sure to report the Leave of Absence dates to Human Resources at the Archdiocese, so that year’s salary does not negatively impact the employee’s pension.


An employee may elect to continue health care for an additional 18 months after the leave of absence or an additional 29 months if the employee is determined disabled under Title II or XVI of the Social Security Act or within 60 days of beginning Continuation; notice of the determination of disability must be provided to the Human Resources office.

Please see the Continuation of Coverage Link for further explanation of this benefit, for forms and for current premiums on Individual or Family coverage.   

FMLA forms

Important – Be sure to get FMLA forms completed as soon as is reasonable.
Incomplete or incorrect information & dates can affect eligibility of employee leave & benefits.
FMLA forms are not sent to Hartford. FMLA forms should be filed at your location separate from the normal employee file with any other medical or private information.

Employee & Doctor FMLA Forms:

1. FMLA Fact Sheet  or  FMLA Fact Sheet/Guide (Spanish)

2. FMLA Leave Request Form (for the employee)
3. Physicians Certification of Employee’s Health Condition  (for the doctor) 
OR  Physicians Certification of the Family Member’s Health Condition 

Employer Forms for the employee:
4. FMLA Employer’s Notification of Eligibility – Required to be given to the employee within 5 days of Employee request for FMLA leave
FMLA Employer’s Response – FMLA Designation Notice – Required to be given to the employee within 5 days of receiving Physicians Certification
Employer’s FMLA Forms:
1. Federal FMLA Fact Sheet for Employers regarding Employer notification requirements