Guidelines for Requesting Family, Medical, or Military Leave

I. For an Employee under the Virginia Sickness Disability Plan who is having surgery or out due to his/her own illness, initiate a claim with UNUM (The Commonwealth of Virginia has contracted the management of this program to a third party administrator, UNUM Life Insurance Company of America. For information on UNUM call toll-free (800) 652-5602, visit the VRS website or contact the UHR Benefits Division for more detailed information. The Family Medical Leave is also administered by UNUM.

II. For an Employee under the Virginia Sickness Disability Plan who is having a baby, initiate a claim with UNUM. In addition, complete a Request for Family or Medical Leave form to request approval of the remaining weeks of the 12 week Family Medical Leave. The form should be sent to the Benefits Division for approval. A Designation Notice is sent within 5 business days to the employee with notice of approval or disapproval. Status of the claim is logged in a spreadsheet, the supervisor is notified of approval or disapproval and the Leave Center is notified of the approval or disapproval.

III. For an Employee on the Personal Sick Plan (the “old sick plan”) who is requesting Family Medical Leave, complete a Request for Family or Medical Leave form and submit it to the Benefits Division for approval. A Designation Notice is sent within 5 business days to the employee with notice of approval or disapproval. Status of the claim is logged in a spreadsheet, the supervisor is notified of approval or disapproval and the Leave Center is notified of the approval or disapproval.

IV. For an Employee applying for Family Medical Leave due to an illness with a family member, complete a Request for Family or Medical Leave form and submit it to the Benefits Division for approval. When such a request is received, a “Certification of Health Care Provider Form” is mailed to the employee to obtain approval from his/her physician or the family member’s physician. The “Certification of Health Care Provider Form” must be completed and returned to the Benefits Division for approval. A Designation Notice is sent within 5 business days to the employee with notice of approval or disapproval. Status of the claim is logged in a spreadsheet, the supervisor is notified of approval or disapproval and the Leave Center is notified of the approval or disapproval.

V. For an Employee applying for Family Medical Leave due to military duty or a family member’s military deployment:

  • employee completes Request for Family or Medical Leave form and submits to the Benefits Division for approval.

  • If basis of claim is military exigency, Benefits sends “Certification of Qualifying Exigency for Military Family Leave” form to employee for completion

  • If basis of claim is illness or injury while on active duty, a “Certification of Health Care Provider Form” is mailed to the employee for physician approval. The form is sent to the Benefits Division for approval. Notice of approval or disapproval is sent to the employee within 5 business days. Status of the claim is logged by Benefits, and the supervisor and Leave Center are notified of approval or disapproval.