Navigating You Through the Leave Process · 2016-07-21 · 2 Kohl’sLeavesafAsbn’acnhndDsitnAesysGeu’nKfs2rsgzzemdnvesq.T.Tp Kohl’s recognizes an Associate may require a leave

Kohl’s supports pursuing good health so you can do the things you love—at home and on the job.

HEALTH

Navigating You Through the

Leave Process

Kohl’s Leave of Absence and Disability Guide

Kohl’s Leave and Disability Guide - Version 7, Effective 3/1/162

Kohl’s recognizes an Associate may require a leave of absence for various reasons. The

purpose of this guide is to navigate Kohl’s Associates through the leave process.

Please be aware that more than one leave policy or program may apply to a specific situation.

Kohl’s policies are referenced throughout this guide; however, this guide should be interpreted

as a summary only and does not contain every policy detail. For further information Associates

should reference Kohl’s Leave Policies through the company intranet or by calling AskHR at

1-844-KohlsHR (844-564-5747).

Kohl’s partners with Sedgwick to administer leave of absence and disability management.

Sedgwick is a leading national third-party administrator of disability, and leave of absence

claims. If you have questions about a leave or need to file a claim contact Sedgwick via AskHR

at 1-844-KohlsHR (844-564-5747).

When an Associate contacts Sedgwick to request a leave of absence there is no guarantee

the request will be approved. Sedgwick will review eligibility and will require documentation to

support the request for leave.

About This Guide

Please note this guide does not cover the procedures for reporting a work-related injury or illness.

Please see your Human Resources Representative or Location Manager if inquiring about a work-related

injury or illness.

Kohl’s Leave and Disability Guide - Version 7, Effective 3/1/16 3

Table of ContentsKOHL’S LEAVE AND DISABILITY GUIDE

04 IMPORTANT CONTACT INFORMATION

05 KOHL’S LEAVE POLICIES

07 ASSOCIATE DISABILITY/LEAVE OF ABSENCE CHECKLIST

08 SEDGWICK LEAVE PROCESS

REPORTING YOUR LEAVE/DISABILITY

DUE DATES FOR SUPPORTING DOCUMENTATION

BENEFIT DETERMINATION

APPLYING FOR AN EXTENSION

BENEFIT DENIAL

APPEAL PROCESS

RETURNING TO WORK

PAID BENEFITS SCHEDULE

USING PTO/WELLNESS HOURS

EXPECTATIONS DURING APPROVED FAMILY OR MEDICAL LEAVE

STATE DISABILITY AND PAID FAMILY LEAVE PROGRAMS

OVERPAYMENTS

LONG TERM DISABILITY

14 BENEFITS INFORMATION

CONTINUATION OF BENEFITS

OPTING OUT OF BENEFITS

LIFE SOLUTIONS

ADDING A NEW CHILD TO YOUR KOHL’S HEALTH PLAN

DEPENDENT/ELDER CARE - SELECT PLUS

16 FAMILY AND MEDICAL LEAVE ACT (FMLA) INTERMITTENT (FMLA)

REPORTING INTERMITTENT ABSENCES

18 NOTICE TO ASSOCIATES OF RIGHTS UNDER FMLA

21 SHORT TERM DISABILITY (STD)

22 PARENTAL AND ADOPTION LEAVE

24 MILITARY LEAVE

25 UNPAID MEDICAL LEAVE OF ABSENCE

26 PERSONAL LEAVE

26 FREQUENTLY ASKED QUESTIONS


Important Contact InfoKOHL’S LEAVE AND DISABILITY GUIDE

SEDGWICK CMSADDRESS PO Box 14424

Lexington, KY 40512

PHONE 877-KOHLS20 (877-564-5720)

FAX 866-315-0607

KOHL’SADDRESS N56 W17000 Ridgewood Drive

Menomonee Falls, WI 53051

AskHR 1-844-KohlsHR (844-564-5747)

HEALTH CARE PROVIDERSUNITED HEALTHCARE 866-204-6092

www.myuhc.com

ANTHEM 877-768-6681 www.anthem.com

KAISER PERMANENTE 800-464-4000 www.kp.org

CIGNA - LONG-TERM DISABILITYADDRESS Two Liberty Place

1601 Chestnut Street Philadelphia, PA 19192

PHONE 800-362-4462

FAX 800-642-8553

WEBSITE www.cigna.com

LIFE SOLUTIONS powered by ComPsych Guidance ResourcesPHONE 877-327-4577

TTD 800-697-0653

WEBSITE www.lifesolutions.guidanceresources.com Company Web ID: KOHLS 0306

DEPENDENT/ELDER CARE - SELECT PLUSWEBSITE www.selectplus.com/kohls

CONEXIS - BENEFIT ARREARS PAYMENTSADDRESS PO Box 660453

Dallas, TX 75266-0453

PHONE 866-206-5751

WEBSITE mybenefits.conexis.com


Kohl’s Leave Policies

FAMILY AND MEDICAL LEAVE ACT (FMLA) Provides up to 12 weeks of unpaid job protected leave, in a rolling 12 month period measured

backwards from the first date of absence, for an FMLA qualifying event. FMLA is federal law and

provides continuous, reduced work schedule, or intermittent leave for the following events:

• An Associate’s own serious health condition;

• Caring for a newborn child, a new child adoption, or foster care;

• Caring for a family member with a serious health condition;

• Qualifying exigencies when a covered family member is on

active duty, or notified of an impending call to active duty.

FMLA also provides up to 26 weeks of unpaid job protected leave to care for the “serious injury or

illness” of a family service member, or to care for the parent of a covered service member when care is

necessitated by the member’s covered active duty.

SHORT-TERM DISABILITY (STD) - FULL-TIME ASSOCIATES ONLYProvides time off work due to disability when an Associate is unable to perform the essential functions

of his or her job as a result of sickness, non-work related injury, or pregnancy. Short-Term Disability

benefits also provide income replacement. Paid benefits vary based on status and years of service. The

maximum benefit period is 26 weeks, and an unpaid waiting period may apply. Unlike FMLA, Short-

Term Disability does not offer job protection.

Kohl’s offers both paid and unpaid leave options. Some paid leave options may run

concurrently with the federal Family and Medical Leave Act (FMLA) or any applicable state

Family Medical Leave(s) (FML).

FMLA & STD SERVE TWO DIFFERENT PURPOSES

JOB PROTECTION (FMLA)FMLA and some state leave laws provide job protection for approved periods of absence.

The approved absence is unpaid, unless there is a concurrent paid leave or paid time off

(such as vacation time/ Paid Time Off).

BENEFIT PAYMENTS (STD)STD provides a paid benefit and accompanying time-off during disability. STD does not

include job protection on its own. The medical standard for receiving disability benefits

is different from FMLA. To receive disability benefits one must be considered totally

disabled from performing the essential functions of his or her job.


Kohl’s Leave PoliciesOTHER COMPANY LEAVESPARENTAL LEAVE - FULL-TIME ASSOCIATES ONLYProvides up to 2 weeks of paid time off work for biological parents, not otherwise eligible for Short-

Term Disability benefits, to care for a child. Leave must be taken within 90 days of the birth of the child.

ADOPTION LEAVE - FULL-TIME ASSOCIATES ONLYProvides up to 2 weeks of paid time off work for adoptive parents for the adoption/placement of a

child. Leave must be taken within 90 days of adoption/placement of the child.

MILITARY LEAVEProvides job protected time off work for active duty as required by the Uniformed Services Employment

and Reemployment Right Act (USERRA). This also includes time off for reserve military training.

• Provides up to 5 years of unpaid leave for active duty.

• Differential pay for up to 2 weeks for annual Reserve Military Training.

UNPAID MEDICAL LEAVE - PART-TIME ASSOCIATES ONLYProvides time off work for a part-time Associate, otherwise not eligible for Short-Term Disability benefits.

Provides up to 26 weeks of unpaid leave for an Associate’s own serious health condition.

PERSONAL LEAVEProvides unpaid time off work for varied personal situations such as education, relocation, non-FMLA

covered situations, family situations, etc. Personal leave does not offer job protection. Approval is based

on business needs and may be denied by the location/department.

STATE PROGRAMSSTATE FAMILY MEDICAL LEAVE AND OTHER STATE LEAVESState Family Medical Leave (FML) is provided by some states, as dictated by state law. State FML is

similar to federal FMLA, however terms vary by state. Other state leaves may include organ/blood

donation, victims of a crime, domestic violence, and school conference/activities, etc.

STATE PAID FAMILY LEAVEIncome replacement is provided by state programs in California and New Jersey, when taking time off

work to care for a family member with a serious health condition or bonding with a child. Coordination

of benefits may apply if eligible for Kohl’s paid Adoption or Parental Leave benefits. Associates must

also apply through the state in which they work. The states determine eligibility and the amount of the

benefit for their programs. For more information see page 15.

STATE DISABILITYState disability programs in California, New York, New Jersey, and Rhode Island provide income

replacement for an Associate off work due to disability. Coordination of benefits may apply if eligible

for Kohl’s Short-Term Disability. Associates must also apply through the state in which they work. The

states determine eligibility and the amount of the benefit for their programs. For more information see

page 14.


Contact Sedgwick at 877-KOHLS20 (877-564-5720)

to report to a current or anticipated absence from

work due to the following reasons:

• Your own serious health condition or disability;

• To care for a family member with a serious health condition;

• For bonding after birth of a child/adoption or foster care placement;

• For a qualified military exigency;

• To care for a covered service member;

• For an impending call to active duty or Reserve Military Training;

• For personal situations.

Contact your manager/location to report your absence and follow your location’s normal call-in

procedures for attendance tracking.

Review the initial packet you receive from Sedgwick and follow the steps as indicated in the

letter. Be sure to review all communications from Sedgwick and return calls to Sedgwick in a

timely fashion.

It is your responsibility to ensure the required documentation is received by Sedgwick on or

before the due date or your leave may be denied. It is suggested that you contact Sedgwick

prior to the due date to confirm your paperwork was received.

Keep in contact with your manager/ location regarding any changes to your return to work date

or any potential accommodations.

One week prior to returning to work contact your manager/location to provide your expected

return to work date.

On the day you return to work contact Sedgwick to confirm that you have returned. If you’re

not able to return to work as anticipated, contact Sedgwick and your manager/location as soon

as possible.

If you have a new child and you wish to add him or her to your Kohl’s health plan, you must add

the child within 45 calendar days. You also have 45 calendar days to increase your Healthcare

Flexible Spending Account (FSA) election or to make an election for Dependent Care FSA.

To make changes go to www.yourtotalrewards.com/kohls and click on “Life Events”. Please

note that you can add your child to your existing plan, but you cannot change plans. For further

questions on reporting life events, call the Benefits Service Center at 888-860-6167.

When applying for a paid or unpaid leave of absence with Sedgwick please use this

checklist as a guide:

ChecklistASSOCIATE DISABILITY/LEAVE OF ABSENCE


Sedgwick Leave ProcessREPORTING YOUR LEAVE/DISABILITY TO SEDGWICKTo report a current or anticipated absence contact Sedgwick CMS at 1-877-KOHLS20

(1-877-564-5720). You must also notify your manager/location of your absence. Early

reporting is strongly encouraged for planned treatment or other events.

SHORT-TERM DISABILITYClaims must be filed within 30 calendar days.

Early reporting is strongly encouraged for planned treatment or other events.

UNPAID LEAVE OF ABSENCE:Claims must be filed within 2 business days

During your initial phone call a Sedgwick Representative will request information and ask

questions relating to your request for leave. Please be advised that you may need to set

aside approximately 5 to 10 minutes for your initial phone call with Sedgwick.

The Sedgwick Customer Service Center is

available from 7 am to 8:30 pm Central

Standard Time, Monday through Friday, to

answer any questions you may have.

Claim intake is available 24 hours a day.


SEDGWICK WILL MAIL YOU AN INITIAL CLAIM PACKET WHICH INCLUDES:

1. A letter explaining the required documentation, including you eligibility for FMLA.

2. An “Authorization for Release of Protected Health Information” form. You must sign the

authorization in order to give your healthcare provider permission to release medical

information to Sedgwick for consideration of your leave request.

a. Provide a copy to your treating healthcare provider.

b. Send a copy with your original signature to Sedgwick.

c. Keep a copy for your records.

3. The required medical paperwork to be completed by your treating healthcare provider. The

medical information required will vary based on the type of leave you are requesting.

4. Any applicable state disability forms, depending on the state in which you work.

Throughout the leave process you will receive phone call and mail correspondence from Sedgwick

updating you on the status of your claim or requesting additional information. It is important that you

pay close attention to the information you receive in the mail from Sedgwick. It is also important you

return calls from Sedgwick in a timely fashion.

DUE DATES FOR SUPPORTING DOCUMENTATIONInformation to support your paid or unpaid leave of absence is due 15 days from the date your initial

packet is mailed to you.

Updated documentation is needed if you continue to be away from work beyond the original approval

period. You will receive a phone call from a Sedgwick Representative approximately 14 days before

your leave ends. Additional documentation is due 15 days from the date an extension is requested.

BENEFIT DETERMINATIONSedgwick will normally make a benefit determination within 2 business days of receiving paperwork,

or the day after your initial due date. If the required documentation is not received timely, your leave

may be denied.

Disability Claims Only:

Please note if your claim requires nurse review or additional medical your benefit determination may

be delayed by up to an additional 10 days.


APPLYING FOR AN EXTENSIONIf you are unable to return to work when your approval period end, contact Sedgwick and your

manager/location as soon as possible. You will need to provide a new expected return to work date.

You will also need to provide updated medical information/documentation to support your extended

absence.

BENEFITS DENIALYour claim for leave/disability benefits may be denied for the following reasons:

• You do not meet eligibility requirements;

• Your paperwork does not substantiate the claim;

• Your paperwork is not received by the due date.

If you are denied an unpaid leave of absence such as FMLA you will need to contact your Human

Resources Representative or Location Manager to discuss other options. There is not an appeals

process for the denial of an FMLA claim. However, if you are denied Short-Term Disability benefits you

have the option to appeal the denial.

EXECUTIVE ASSOCIATES ONLYA denial of benefits may result in an overpayment of your regular salary. See the overpayment section

on page 14 for more information.

It is your responsibility to make sure all documentation relevant to your absence is received by Sedgwick on or before the designated due date. If Sedgwick does not receive your information timely, your claim may be denied and you may not receive benefit payments and/or leave approval.


APPEAL PROCESS FOR SHORT-TERM DISABILITY1. You have 90 days from the date you receive the denial letter to file a written appeal. An

appeal form is included with your denial letter.

2. Once your appeal form is submitted to Sedgwick you will have 45 days to submit additional

medical documentation to support your claim for benefits.

3. An independent Appeal Specialist will complete a separate review of your claim and make a

benefit decision within 45 days of Sedgwick’s receipt of additional medical documentation.

4. If your appeal is overturned (in part or in whole) you will receive approved benefits

retroactively.

5. If your appeal is upheld you will not receive benefits and the denial will remain. Please

contact your Human Resources Representative or Location Manager.

6. If you continue to be absent during your appeal, your location’s attendance policy may apply.

Please contact your Human Resources Representative or Location Manager to discuss your

location’s administrative practice.

RETURNING TO WORKYou are required to inform Sedgwick of your intent to return to work before the end of your leave or to

request an extension, if available. If the circumstances of your leave change and you are able to return

to work earlier than the date indicated, you will be required to notify Sedgwick and your manager/

location at least two workdays prior to the date you intend to return to work.

If your healthcare provider indicates you are able to return to work with restrictions, you must provide

a copy of the restrictions to Sedgwick. A Sedgwick Representative will work with you, your Human

Resources Representative/Location Manager, and your healthcare provider as needed to facilitate

your return to work. If you are not able to return to work and your leave or disability benefits have

exhausted, contact your Human Resources Representative or Location Manager to discuss other

options or possible accommodations.

One week prior to returning to work contact your manager/

location to provide your expected return to work date.

On the day you return to work contact Sedgwick to confirm

you have returned.

ChecklistRETURNING TO WORK


Sedgwick Leave ProcessPAID BENEFITS SCHEDULEIf approved for a paid leave you will receive paid benefits through Kohl’s in the same format (i.e. direct

deposit) and on the same frequency (i.e. weekly or bi-monthly) as you currently receive your salary or

hourly wages. However, your benefits may be delayed for the following reasons:

• Payment of benefits may be delayed if Sedgwick is unable to make a benefit decision before

payroll runs for the current pay period. For example, if you delay in reporting your claim or in

providing medical information to support your disability, Sedgwick may not be able to make

a benefit decision until after payroll has run for the current pay period. It is important that

Sedgwick receives medical information from your healthcare provider as soon as possible.

Once benefits are approved they will be paid retroactively during the next pay period.

• When you return to work payment of your regular wages may be a delayed on your first

regular paycheck, due to the timing of when payroll runs and when confirmation of your

return is received. It is important that you and your location/manager confirm your return to

work with Sedgwick as soon as possible.

USING PAID TIME OFF (PTO)/WELLNESS HOURSDuring an unpaid leave you may elect (or may be required) to substitute accrued PTO/Wellness Hours.

Use of any available PTO/Wellness Hours will run concurrently with your unpaid leave. Associates can-

not use PTO/Wellness Hours to supplement a paid or partially paid leave. The process for requesting

PTO/Wellness Hours during an unpaid absence is listed below.

HOURLY (NON-EXEMPT) ASSOCIATESHourly Associates may use accrued PTO/Wellness Hours during any unpaid waiting period or during

an unpaid leave. To request PTO/Wellness Hours contact your manager/location.

EXECUTIVE & SALARIED OVERTIME ELIGIBLE (SOTE) ASSOCIATESExecutive Associates may use accrued PTO/Wellness Hours during an unpaid leave. To request PTO/

Wellness Hours notify your manager/location and also send an email with the time requested to:

[email protected]. The email should include your Associate ID, dates of the unpaid leave,

and the number of days requested.

EXPECTATIONS DURING YOUR APPROVED FAMILY OR MEDICAL LEAVE When off work on an approved family or medical leave, Kohl’s prohibits any type of work for

Kohl’s to be performed based upon state and federal law. Kohl’s asks all Associates to comply

with this requirement and encourages any questions be directed to your manager, the Human

Resources Department, or the Respect line 1-877-99KOHLS. (Note that for nonexempt (hourly

paid) Associates, any time spent working must be counted as hours worked.) If any exception

to the general rule of not performing any work while on a leave is requested, the Associate and

manager together must contact Human Resources for approval.


Sedgwick Leave ProcessSTATE DISABILITY & PAID FAMILY LEAVE PROGRAMSSTATE DISABILITY (ASSOCIATES WORKING IN CA, NY, NJ, RI)State disability programs in California, New York, New Jersey and Rhode Island provide income

replacement for an Associate off work due to disability. Coordination of benefits may apply if eligible

for Kohl’s Short-Term Disability.

STATE PAID FAMILY LEAVE (ASSOCIATES WORKING IN CA, NJ, RI)Income replacement is provided by state programs in California, New Jersey and Rhode Island when

taking time off work to care for a family member with a serious health condition or bonding with a child.

Coordination of benefits may apply if eligible for Kohl’s paid Adoption or Parental Leave benefits.

OFFSET PAYMENTSYour Kohl’s benefit payment may be offset by the maximum state disability or paid family leave benefit,

rather than the actual benefit amount. If the amount of benefit offset is greater than actual benefits

received from the state, a copy of the state award letter must be submitted to Sedgwick. Once Sedgwick

receives a copy of the state award letter any additional pay owed will be issued to the Associate.

Associates may experience a delay in receiving the full benefit payments, as payment may be coming

from Kohl’s and also the state. For questions about this process contact your Sedgwick Representative.

ASSOCIATE’S RESPONSIBILITY1. Apply for state benefits through the state in which you work. The states determine eligibility and

the amount of the benefit for their programs.

2. Follow Kohl’s application process for Short-Term Disability, Adoption, or Parental Leave benefits.

Kohl’s makes an independent determination of eligibility and amount of benefit based on

company policy and administrative rules.

3. Submit a copy of the state award letter to Sedgwick if the amount of the Kohl’s benefit offset is

greater than actual benefits received from the state.

OVERPAYMENTS: It is possible that you may be overpaid during a leave of absence. An overpayment

situation may occur for various reasons, which can include a miscalculation of your

benefit, an early return from leave, etc. In the event that an overpayment situation

occurs, you are responsible for returning the overpayment to Kohl’s.


CONTINUATION OF BENEFITSMissed benefit premium payments can result from leaves due to paycheck timing, missed paychecks,

or paychecks that are too low to cover your premiums. If this happens, an invoice will be mailed

from CONEXIS to your home address with instructions on how to make payment. Payments are not

accepted for future due premiums. Premium payments may be mailed directly to CONEXIS in the

form of check or money order to the address below:

CONEXIS

PO Box 660453

Dallas, TX 75266-0453

In addition, CONEXIS can also accept online payments. To take advantage of the online payment

option, please visit CONEXIS’ website at mybenefits.conexis.com.

To understand your Kohl’s benefit costs, you may check your Benefits Summary to find your weekly

or bi-weekly premiums. Your Benefits Summary can be accessed at yourtotalrewards.com/kohls.

If you have any questions regarding your benefit premium(s) owed, contact CONEXIS Customer

Service Center at 866-206-5751.

Benefits Information

LONG-TERM DISABILITY - FULL-TIME ASSOCIATES ONLY

If you have elected Long-Term Disability (LTD) benefit coverage, Sedgwick will assist if a transition

to Long-Term Disability is needed. Once an LTD enrolled Associate reaches 120 days of disability,

Sedgwick will automatically initiate a claim with CIGNA (Long-Term Disability insurance carrier). This

in no way indicates the need for or the approval of Long-Term Disability; however, it allows CIGNA

enough time to process the claim, in the event you exhaust your benefits under Kohl’s Short-Term

Disability program.

CIGNA will mail an LTD packet to you and a CIGNA representative will contact you to assist with your

application and potential transition to LTD benefits. If you are able to return to work before your 26

weeks of Short-Term Disability ends then CIGNA will cancel your claim. However if you exhaust Short-

Term Disability benefits after 26 weeks and you are unable to return to work, then CIGNA will make a

benefit decision on your claim.

For more information contact CIGNA at 800-362-4462. LTD is a voluntary benefit and is an insured

program under which CIGNA makes all claim decisions.


OPTING OUT OF BENEFITS While on an approved FMLA or Military leave you have the option to suspend (or

terminate) you welfare benefits. You also have the option to reinstate your welfare

benefits upon your return to work. If you wish to suspend (or terminate) coverage

contact AskHR at 1-844-KohlsHR (844-564-5747).

LIFE SOLUTIONS powered by ComPsych Guidance ResourcesThe Kohl’s Life Solutions program provides support, resources and information for a variety of personal

and work-life issues. Whether you’re looking for childcare or eldercare, dealing with marital issues or

depression, or looking for resources to deal with financial concerns, Life Solutions is here to help.

Life Solutions is company-sponsored and designed to assist you and your family with managing

everyday life. You can contact Life Solutions 24 hours a day, 7 days a week at 877-327-4577, or visit

online: www.lifesolutions.guidanceresources.com (Company Web ID: KOHLS0306).

ADDING A NEW CHILD TO YOUR KOHL’S HEALTH PLANIf you plan to add a new child to your Kohl’s health plan, increase your Healthcare Flexible Spending

Account (FSA) election, or make an election for Dependent Care FSA, you must do so within 45 days

of the birth/adoption placement of your child. Please note you can add your child to your Kohl’s health

plan before you receive your child’s social security number. However you will need to provide the social

security number when you receive it by calling the Benefits Service Center at 888-860-6167.

To make changes go to www.yourtotalrewards.com/ kohls and click on “Life Events”. Please note that

you can add your child to your existing plan, but you cannot change plans. For further questions on

reporting a life event, call the Benefits Service Center at 888-860-6167.

DEPENDENT/ELDER CARE - SELECT PLUSKohl’s offers a dependent care benefit to all full-time and part-time Associates, in partnership with

Select Plus. Select Plus offers a network of providers for child care (babysitter, nanny, emergency child

care) and elder care (in-home, or short term care), as well as assistance finding an elder care facility.

All providers have gone through a comprehensive background check. You simply need to activate

your membership and select a provider that meets your needs and budget. You can activate your free

membership at www.selectplus.com/kohls.


DEFINITIONThe Family Medical Leave Act (FMLA) is a federal act signed into law in 1993. FMLA allows “eligible”

Associates up to 12 weeks of unpaid, job protected leave for continuous, reduced work schedule, or

intermittent time off for the following qualified reasons:

• Birth/adoption of a child, or placement of a child in foster care;

• Caring for a spouse, son, daughter, parent, or person standing in loco parentis who has a

serious health condition;

• For the Associate’s own serious health condition;

• To address certain qualifying exigencies for eligible employees with a spouse, son, daughter

or parent on active duty or call to active duty status.

FMLA also includes a special leave entitlement that provides eligible Associates up to 26 weeks of

leave during a 12-month period to care for a covered service member due to a serious illness or injury,

or to care for the parent of a covered service member when care is necessitated by the member’s

covered active duty. Eligible Associates must be the spouse, son, daughter, parent, or nearest blood

relative of the covered service member.

For all reasons FMLA offers job protection, which means if the Associate returns to work on or before

the end of his or her approved 12 or 26 week period he or she will be restored to the same or similar

job position.

ELIGIBILITY REQUIREMENTSEligible Associates must have 12 months of service and must have worked 1,250 hours in a rolling

12 month period measured backwards from the first date of absence. Hours worked do not include

vacation time, non-worked holidays, etc.

ASSOCIATE BENEFITAssociates are eligible for up to 12 weeks of unpaid, job protected leave for certain FMLA qualifying

events, and up to 26 weeks to care for a covered service member, or to care for the parent of a

covered service member when care is necessitated by the member’s covered active duty.

Family Medical Leave Act (FMLA)


INTERMITTENT FMLAIntermittent FMLA is unpaid job protected leave when time off occurs occasionally, often a few hours

at a time, and does not need to be continuous. Intermittent FMLA is typically used to cover time off

for doctor’s appointments, or flare-ups of a serious health condition. Approval for Intermittent FMLA

requires medical certification from your healthcare provider.

Intermittent FMLA can be used for an Associate’s own serious health condition or for an eligible family

member’s serious health condition. Kohl’s may allow Intermittent FMLA for bonding with a newborn

child, adoption, and foster care; however, Intermittent FMLA for baby bonding is subject to restrictions

of frequency and requires business/HR approval (unless otherwise required by state leave laws).

Associates are required to work with management to pre-schedule intermittent leave to cause the

least amount of disruption to the business/operations.

REPORTING INTERMITTENT ABSENCESAssociates need to report each and every intermittent absence to Sedgwick and follow their location/

department’s normal call-in procedures. Associates must work with their manager/location to

schedule appointments outside of work hours if possible. Intermittent absences must be called in

to Sedgwick before the absence occurs, or on the same day of the absence. Absences not called in

within this time frame may be denied. Absences can be called in to Sedgwick at 877-KOHLS20

(877-564-5720), 24 hours a day, 7 days a week.

If an Associate goes outside of the intermittent leave approved frequency and duration noted on the

medical certification, the absence may not be approved. The unapproved absence will be handled

according to the location/department’s attendance policy. In addition the Associate may be required

to recertify the frequency/duration of the intermittent leave.

If you have an absence that does not qualify under FMLA due to late reporting, this absence may be

counted under your location/department’s attendance policy. Please contact your Human Resources

Representative or Location Management to discuss the attendance policy.


ASSOCIATES RIGHTS AND RESPONSIBILITIES UNDER THE FEDERAL FAMILY AND MEDICAL LEAVE ACT

BASIC LEAVE ENTITLEMENTFMLA requires covered employers to provide up to 12 weeks of unpaid, job-protected leave to eligible

Associates for the following reasons:

• For incapacity due to pregnancy, prenatal medical care or child birth;

• To care for the Associate’s child after birth or placement for adoption or foster care;

• To care for the Associate’s spouse, son or daughter, or parent, who has a serious health

condition; or

• For a serious health condition that makes the Associate unable to perform his/her job.

MILITARY FAMILY LEAVE ENTITLEMENTSEligible Associates with a spouse, son, daughter or parent on active duty or call to active duty

status in the National Guard or Reserves may use their 12-week leave entitlement to address certain

qualifying exigencies. Qualifying exigencies may include addressing issues that arise due to short-

notice deployment, attending certain military events, arranging for alternative childcare, addressing

certain financial and legal arrangements, attending certain counseling sessions and attending post-

deployment reintegration briefings, and caring for a military member’s parent who is incapable of self-

care when the care is necessitated by the member’s covered active duty.

FMLA also includes a special leave entitlement that permits eligible Associates to take up to 26

weeks of leave to care for a covered servicemember during a single 12-month period. A covered

servicemember is:

• A current member of the Armed Forces, including a member of the National Guard or

Reserves, who is undergoing medical treatment, recuperation, or therapy, is otherwise in

outpatient status, or is otherwise on the temporary disability retired list;or

• A veteran is undergoing medical treatment, recuperation, or therapy for a serious injury or

illness, and who was discharged or released under conditions other than dishonorable at any

time during the five-year period prior to the first date the eligible employee takes FMLA leave

to care for the covered veteran.

The FMLA definitions of “serious injury or illness” for current servicemembers and veterans are distinct

from the FMLA definition of “serious health condition.” See Policy 104 Family and Medical Leave Act

for definitions of terms.

Notice to Associates of Rights under FMLA


BENEFITS AND PROTECTIONSDuring FMLA leave, an Associate may maintain his/her health coverage under any group health plan

on the same terms as if (s)he had continued to work. However, the Associate is responsible for paying

any Associate contributions for health coverage during the unpaid FMLA leave. Upon return from

FMLA leave, most Associates must be restored to their original or equivalent positions with equivalent

pay, benefits and other employment terms. Use of FMLA leave cannot result in the loss of any

employment benefit that accrued prior to the start of an Associate’s leave.

DEFINITION OF SERIOUS HEALTH CONDITIONA serious health condition is an illness, injury, impairment or physical or mental condition that involves

either an overnight stay in a medical care facility or continuing treatment by a healthcare provider for

a condition that either prevents the Associate from performing the function of his/her job or prevents

the qualified family member from participating in school or other daily activities. Subject to certain

conditions, the continuing treatment requirement may be met by a period of incapacity of more than

three consecutive calendar days combined with at least two visits to a health care provider or one visit

and a regimen of continuing treatment, or incapacity due to pregnancy, or incapacity due to a chronic

condition. Other conditions may meet the definition of continuing treatment.

USE OF LEAVEAn Associate does not need to use this leave entitlement in one block. Leave can be taken

intermittently or on a reduced leave schedule when medically necessary. Associates must make

reasonable efforts to schedule leave for planned medical treatment so as not to unduly disrupt Kohl’s

operations. Leave due to qualifying exigencies may also be taken on an intermittent basis.

SUBSTITUTION OF PAID LEAVE FOR UNPAID LEAVEAssociates may choose or Kohl’s may require use of accrued paid leave while taking FMLA leave. In

order to use paid leave for FMLA leave, Associates must comply with Kohl’s normal paid leave policies.

ELIGIBILITY REQUIREMENTSAssociates are eligible if they have worked for Kohl’s for at least one year, worked at least 1,250 hours

during the 12-month period immediately preceding the commencement of leave, and if at least 50

Associates are employed by Kohl’s within 75 miles.


EMPLOYEE RESPONSIBILITIESAssociates must provide 30 days advance notice of the need to take FMLA leave when the leave

is foreseeable. When 30 days notice is not possible, the Associate must provide notice as soon as

practicable and generally must comply with Kohl’s normal call-in procedures.

Associates must provide sufficient information for Kohl’s to determine if the leave may qualify for

FMLA protection and the anticipated timing and duration of the leave. Sufficient information may

include that the Associate is unable to perform job functions, the family member is unable to perform

daily activities, the need for hospitalization or continuing treatment by a health care provider, or

circumstances supporting the need for military family leave. Associates also must inform Kohl’s if the

requested leave is for a reason for which FMLA was previously taken or certified. Associates also are

required to provide a certification and periodic recertification supporting the need for leave.

EMPLOYER RESPONSIBILITIESKohl’s will inform Associates requesting leave whether they are eligible under FMLA. If they are,

the notice will specify any additional information required as well as the Associate’s rights and

responsibilities. If they are not eligible, Kohl’s will provide a reason for the ineligibility.

Kohl’s also will inform eligible Associates if leave will be designated as FMLA-protected and the

amount of leave counted against the Associate’s leave entitlement. If Kohl’s determines that the leave

is not FMLA-protected, Kohl’s also will notify the Associate.

UNLAWFUL ACTS BY EMPLOYERSFMLA makes it unlawful for any employer to:

• Interfere with, restrain, or deny the exercise of any right provided under FMLA;

• Discharge or discriminate against any person for opposing any practice made unlawful by

FMLA or for involvement in any proceeding under or relating to FMLA.

ENFORCEMENTAn employee may file a complaint with the U.S. Department of Labor or may bring a private lawsuit

against an employer. FMLA does not affect any Federal or State law prohibiting discrimination, or

supersede any State or local law or collective bargaining agreement, which provides greater family or

medical leave rights.

For additional information contact: 1-866-4US-WAGE (1-866-487-9243) TTY: 1-877-889-5627 or www.wagehour.dol.gov or see Kohl’s Policy No. 104.

FMLA section 109 (29 U.S.C. § 2619) requires FMLA covered employers to post the text of this notice. Regulations 29 C.F.R. § 825.300(a) may require additional disclosures.

NOTICE TO ASSOCIATES OF RIGHTS UNDER FMLA (contnued)


Short-Term Disability (STD)DEFINITIONKohl’s provides income replacement for time off work due to disability when an Associate is unable to

perform the essential functions of his or her regular occupation as a result of sickness, non-work related

injury, or pregnancy. You must be totally disabled from performing the essential functions of your job in

order to be eligible for benefits.

To be eligible for Short-Term Disability benefits your absence must be supported by objective medical

evidence from your treating healthcare provider that explains why you are unable to perform your

essential job duties. It is important that your healthcare provider complete the Attending Physician

Statement and provide any additional supportive medical records.

If eligible and entitled, disability benefits will run concurrently with federal and state leaves of absence

for the Associate’s own condition. It is important to note that the definition of a disability is held to a

higher medical standard than the FMLA’s definition of a serious health condition.

ELIGIBILITY REQUIREMENTSFULL-TIME HOURLY ASSOCIATESEligible after 180 calendar days of continuous service, with a 7 day unpaid waiting period. The waiting

period may be waived in certain situations, such as in-patient hospitalization.

EXECUTIVE & SALARIED OVERTIME ELIGIBLE (SOTE) ASSOCIATESEligible upon date of hite. No waiting period; however, the absence must exceed 3 consecutive

calendar days.

ASSOCIATE BENEFITThe maximum benefit is 26 weeks, including any applicable waiting period.

FULL-TIME HOURLY ASSOCIATESPaid leave is 60% of the Associate’s regular hourly rate based on a 40 hour work week.

EXECUTIVE & SALARIED OVERTIME ELIGIBLE (SOTE) ASSOCIATES

LENGTH OF SERVICE Less than 1 year

1 to 2 years

More than 2 years

STD BENEFIT 13 weeks at base salary (100%) followed by 13

weeks at one-half base salary (50%)

13 weeks at base salary (100%) followed by 13

weeks at three-quarters base salary (75%)

26 weeks at base salary (100%)


DISABILITY PAYDisability payments are paid in the same format and on the same frequency you currently receive your

salary or hourly wages, unless benefits are delayed due to timing. In such cases retroactive payment

will be made accordingly and disability payments will be scheduled for the next regular payroll cycle.

WAITING PERIODFULL-TIME HOURLY ASSOCIATESThere is a 7 day unpaid waiting period for full-time hourly Associates. The waiting period begins the

first scheduled day the Associate is absent from work. Benefits are not payable during the waiting

period, unless the Associate is admitted for inpatient hospital stay. Observation is not considered

inpatient hospital stay.

EXECUTIVE & SALARIED OVERTIME ELIGIBLE (SOTE) ASSOCIATESAbsence due to disability must exceed 3 consecutive calendar days before the Associate becomes

eligible for disability benefit payments. After 3 consecutive calendar days the Associate becomes

eligible for payment retroactively, effective the first day of the consecutive period of absence. The

Associate becomes eligible for disability benefit payments the first day of hospital confinement, even

if the absence has not exceeded 3 consecutive days.

Parental & Adoption LeavePARENTAL LEAVE DEFINITIONKohl’s offers a Parental Leave of Absence for up to 2 weeks of paid leave for the birth of an

Associate’s biological child. This leave is typically taken by fathers, however it would also apply to a

mother provided she is not eligible for paid benefits for recovery from childbirth/disability under any

other Kohl’s policy. Parental Leave must be taken within 90 days of the birth of the child. Parental

leave can not be taken intermittently, however it may be taken in 2, one-week increments.

PARENTAL LEAVE ELIGIBILITY REQUIREMENTSFULL-TIME HOURLY ASSOCIATESEligible after 180 days of continuous service.

EXECUTIVE & SALARIED OVERTIME ELIGIBLE (SOTE) ASSOCIATESEligible upon date of hire.


ADOPTION LEAVE DEFINITIONThe Kohl’s Adoption Assistance Program provides up to 2 weeks of paid leave upon adoption

placement of a child in the home, prior to adoption being finalized. Associates have 90 days either

upon placement of the child or adoption finalization in which to use the paid leave. Adoption leave can

not be taken intermittently, however it may be taken in 2, one-week increments. This program excludes

the adoption of a biological child of either adopting parent and the adoption of a blood relative or

biological child to the spouse of an adopting parent.

ADOPTION LEAVE ELIGIBILITY REQUIREMENTSFULL-TIME HOURLY ASSOCIATESEligible after 180 days of continuous service.

EXECUTIVE & SALARIED OVERTIME ELIGIBLE (SOTE) ASSOCIATESEligible upon date of hire.

PARENTAL & ADOPTION LEAVE ASSOCIATE BENEFITFULL-TIME HOURLY ASSOCIATESPaid leave at 60% of the Associate’s regular hourly rate based on a 40 hour work week,

for up to 2 weeks.

EXECUTIVE & SALARIED OVERTIME ELIGIBLE (SOTE) ASSOCIATESPaid leave at 100% of base salary for up to 2 weeks.

PAID PARENTAL AND PAID ADOPTION LEAVESPaid Parental and Adoption Leaves do not run

concurrent with FMLA/State FML. If the Associate

wishes to take bonding time beyond the Parental or

Adoption Leave, an FMLA/State FML claim should be

requested and approval is dependent upon FMLA/

State FML eligibility and entitlement.


Military LeaveDEFINITIONMILITARY LEAVEProvides unpaid job protected time off work for active military duty as required by the Uniformed

Services Employment and Reemployment Rights Act (USERRA). Associates are eligible for a Military

Leave of Absence for up to 5 years of cumulative military service.

RESERVE MILITARY TRAININGIf an Associate is a member of the National Guard or a Reservist and leaves work for annual training,

the Associate shall be granted a leave of absence with a pay differential. A Reservist or National Guard

member will be paid the difference between his or her average weekly salary and military pay for up

to 2 weeks each year, if the military pay is less than the Associate’s standard weekly pay. For more

information please contact Kohl’s Absence Management Team at 866-219-1762, or send an email to:

[email protected].

ELIGIBILITY REQUIREMENTSEligible upon date of hire.

ASSOCIATE BENEFIT • Up to 5 years of unpaid leave for active duty.

• Differential pay for up to 2 weeks of annual Reserves training.

KOHLS’ BENEFITS WHILE ON A MILITARY LEAVEIf the Military Leave period is more than 30 days an eligible Associate will not receive company-

paid medical, dental, vision, or Long-Term Disability (LTD) benefits beginning 31 days following the

start date of active duty. However a continuation conversion option for medical coverage is available

through COBRA. If the tour of duty is 30 days or less medical, dental, vision, or LTD benefits will be

continued and the Associate must pay his or her normal share of the Associate contribution. Life

Insurance will end the date active service begins. An Associate can request to have benefits reinstated

upon returning to work from Military Leave.

MILITARY LEAVEProvides up to 5 years

of unpaid, job protected

time off work.

RESERVE MILITARY TRAININGProvides a pay differential for up to 2 weeks

each year for annual National Guard or

Reservist Training (if military pay is less than the

Associate’s standard weekly pay).


Unpaid Medical Leave of AbsencePART-TIME HOURLY ASSOCIATES ONLY

DEFINITIONKohl’s offers an Unpaid Medical Leave of Absence for an Associate’s own serious health condition.

This is a leave option for part-time Associates who are otherwise not eligible for Short-Term Disability

benefits. Unpaid Medical Leave is similar to federal FMLA; however, there is no job protection under

this policy alone. If applicable, Unpaid Medical Leave will run concurrent with federal FMLA/State FML

(providing job protection).

ELIGIBILITY REQUIREMENTSThis benefit is for part-time Associates with 12 months of continuous service or more. There is no

hours worked requirement.

ASSOCIATE BENEFITProvides up to 26 weeks of unpaid leave in a rolling 12-month period.


Frequently Asked QuestionsPersonal LeaveDEFINITIONKohl’s offers an unpaid Personal Leave of absence for varied personal situations such as education,

relocation, non-FMLA covered situations, family situations, etc. Personal Leave does not offer job

protection. Approval is based on business needs.

ELIGIBILITY REQUIREMENTSFULL-TIME HOURLY ASSOCIATESAssociates become eligible after 6 months of continuous service.

PART-TIME HOURLY ASSOCIATESAssociates become eligible after 1 year of continuous service.

EXECUTIVE & SALARIED OVERTIME ELIGIBLE (SOTE) ASSOCIATESAssociates become eligible after 90 days of continuous service.

ASSOCIATE BENEFITFULL-TIME & PART-TIME HOURLY ASSOCIATESProvides up to 2 weeks of unpaid leave, plus 1 additional week for each year of service. The maximum

benefit is 8 weeks per calendar year.

EXECUTIVE & SALARIED OVERTIME ELIGIBLE (SOTE) ASSOCIATESProvides up to 12 weeks of unpaid leave per calendar year.

Frequently Asked QuestionsWHAT SHOULD I DO IF I AM NOT ELIGIBLE FOR FMLA? If Sedgwick advises that you are not eligible for FMLA you should contact your Human Resources

Representative to discuss other options. Part-Time Associates not eligible for FMLA may be eligible for

an Unpaid Medical Leave of Absence.

WHY SHOULD I SIGN THE “AUTHORIZED FOR RELEASE OF PROTECTED HEALTH INFORMATION” FORM?Under the guidelines of the Health Information Portability and Accountability Act (HIPPA) your

healthcare provider must have your permission to release any information to Sedgwick relating to your

illness. You provide that permission by signing the Release for Information form.


IF MY HEALTHCARE PROVIDER REQUIRES PAYMENT FOR PROVIDING MEDICAL RECORDS, WHO IS RESPONSIBLE FOR MAKING THE PAYMENT?You are responsible for making payments to provide medical records for your disability/leave of absence

claim. Sedgwick and/or Kohl’s will not pay for medical records and will not pay for forms to be completed.

WHAT HAPPENS TO MY PTO/WELLNESS HOURS ACCRUAL WHILE I’M OUT ON LEAVE?Kohl’s Associates will continue to accrue PTO/Wellness Hours during a paid or unpaid leave.

CAN I USE PTO/WELLNESS HOURS TO MAKE UP THE DIFFERENCE WHEN MY SHORT-TERM DISABILITY IS PAID AT 60%?You cannot use PTO/Wellness Hours to supplement pay when receiving benefits under Short-Term

Disability. However you can take PTO/Wellness Hours during any unpaid waiting period while on Short-

Term Disability or during an unpaid leave.

WILL I RECEIVE HOLIDAY PAY WHEN I AM ON AN UNPAID LEAVE?You will only receive holiday pay during an unpaid leave if you use PTO/Wellness Hours for the remainder

of the holiday week.

CAN I APPLY FOR LEAVE TO CARE FOR MY DOMESTIC PARTNER?Contact Sedgwick for further details on your leave options.

AM I REQUIRED TO SHARE MY FMLA TIME WITH MY SPOUSE SINCE WE BOTH WORK AT KOHL’S?Married Associates are required to split their 12 weeks of FMLA if they are both employed by Kohl’s and

leave is taken for bonding due to birth, adoption/foster care, or leave to care for a parent.

WILL I RECEIVE A SEPARATE W2 FORM FROM SEDGWICK FOR DISABILITY BENEFITS PAID TO ME?No. Kohl’s is paying the benefit therefore you will not receive a W-2 from Sedgwick.

ARE MY DISABILITY BENEFITS TAXABLE?Yes. Disability benefits are subject to all federal, state, and local taxes.

WHAT HAPPENS IF I BECOME DISABLED AGAIN?This is called a relapse claim. It depends on the length of time between your return to work and your date

of relapse. If you have returned to continuous active work for 30 calendar days or less, it is considered one

period of disability for the purposes of calculating the rate of pay and the maximum benefit period. This

means your current disability period is added to your prior disability period and no waiting period applies.

HOW LONG DO I NEED TO BE BACK AT WORK BEFORE BECOMING ELIGIBLE FOR A NEW 26 WEEK DISABILITY BENEFIT PERIOD?If you become disabled again with the same or related condition you will start a new 26 week benefit

period after returning to work for more than 30 days from your last period of disability. If your new

condition is completely unrelated to your previous disability, you may be eligible for a new 26 week

schedule of benefits, regardless of the amount of time between the two disability periods.


Frequently Asked QuestionsWHO DO I ASK IF I HAVE QUESTIONS THAT SEDGWICK CANNOT ANSWER? Sedgwick is able to answer most all questions related to the administration of your leave. However if

you have a Kohl’s specific question that Sedgwick is unable to answer please reach out to AskHR at

1-844-KohlsHR (844-564-5747).

WHAT SHOULD I DO IF MY LEAVE IS EXHAUSTING AND I NEED MORE TIME OFF WORK DUE TO DISABILITY?Contact your manager/location to begin the interactive process regarding your needs and concerns.

The interactive process allows Kohl’s to understand an Associate’s requests and determine the range of

accommodations that may work in a location/business area. Information is available on the company

intranet. You may also contact your Human Resources Representative for more information.

WHAT IF MY DOCTOR ADVISES I WILL HAVE NEW LIMITATIONS WHEN I RETURN TO WORK THAT I DID NOT HAVE PRIOR TO MY LEAVE?Contact your manager/location to discuss your needs and concerns. Individuals with disabilities are

valued members of the Kohl’s team and will be provided with a reasonable accommodation so long as

it does not create an undue hardship on the business. Kohl’s is committed to engaging in an interactive

process to assist in determining the needs of Associates with disabilities and to provide appropriate

accommodations in the workplace. You may also contact your Human Resources Representative to

discuss your concerns.

I AM CONCERNED MY MEDICAL CONDITION WILL IMPACT MY JOB. SHOULD I DISCUSS MY MEDICAL CONDITION WITH MY MANAGER/LOCATION?Kohl’s recruits, hires, trains, and promotes individuals in all job titles without regard to physical or

mental disability or any other status protected by federal, state or local law. Your Human Resources

Representative or Location Manager will want to talk with you to understand your medical condition

and determine how the condition may impact your job. Sometimes individual circumstances unique to

your condition, job description, or other factors impact the decision. Your participation is an important

part of the discussion. The interactive process allows Kohl’s to understand an Associate’s requests and

determine the range of accommodations that may work in a location/business area.

WHAT IF I DON’T FEEL COMFORTABLE TALKING ABOUT MY MEDICAL CONDITION WITH MY MANAGER OR LOCATION REPRESENTATIVE?If for any reason you feel uncomfortable discussing your medical condition with your manager/location,

you are encouraged to contact your Human Resources Representative. If you do not know how to

contact your Human Resources Representative call AskHR at 1-844-KohlsHR (844-564-5747).

CAN I APPLY PAID SICK TIME TO MY UNPAID LEAVE OF ABSENCE OR UNPAID WAITING PERIOD?Yes. Similar to PTO, you can apply Paid Sick Time to your unpaid leave of absence or unpaid

waiting period.

DOES PAID SICK TIME RUN CONCURRENTLY WITH STATE OR FEDERAL LEAVES?No.


Notes


Notes


Notes

Documents

Navigating You Through the Leave Process · 2016-07-21 · 2 Kohl’sLeavesafAsbn’acnhndDsitnAesysGeu’nKfs2rsgzzemdnvesq.T.Tp Kohl’s recognizes an Associate may require a leave