(Please scroll down for LOA - Health Insurance Information)

Medical Leave

The Family and Medical Leave Act (FMLA) requires employers to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for the following reasons:  for incapacity due to pregnancy, prenatal medical care or childbirth; to care for the employee's child after birth, or placement for adoption or foster care; to care for the employee's spouse, child or parent who has a serious health condition; or for a serious health condition that makes the employee unable to perform the employee's job.

Please see the employee rights and responsibilities under the Family and Medical Leave Act at this link:

Employee Rights and Responsibilities

The Board of Education adopted policy GBGF on February 28, 2017.  Please visit the following link for more information regarding FMLA leave:


Below are the links to the FMLA forms. The first is the certification form if the leave of absence is for the employee.  The second is the certification form for the care of a family member.  Please note the majority of these forms are required to be completed by a physician. 

Employee FMLA Form

Family Member FMLA Form

In addition to the appropriate form above, we also require the completion of the district Leave of Absence form:

District LOA Form

FMLA guarantees the employee's position (or an equivalent position with equivalent pay, benefits, and working conditions) for up to 12 weeks and pays the employee's health benefits.  The district requires the forms above to be completed and returned before an employee can be placed on medical leave.  If the return to work date is changed, the physician must provide written documentation with these modifications to our office.

The district uses accrued leave balances toward leaves of absence unless written notification is given to Human Resources to use unpaid leave.  Notification must be received prior to the beginning of the leave.  After accrued leave is exhausted, the remaining time on leave is unpaid.  Classified employees can request extended sick leave, and licensed staff members enrolled in the sick bank may be able to access additional sick bank days.  See the forms below:  

Classified Extended Sick Leave Form

Licensed Sick Bank Application





Military Leave

Eligible employees with a spouse, child, or parent on active duty or called to active duty status in the National Guard or Reserves in support of a contingency operation may use their 12-week leave entitlement to address certain qualifying exigencies.  Qualifying exigencies may include attending certain military events, arranging for alternative childcare, addressing certain financial and legal arrangements, attending certain counseling sessions, and attending post-deployment reintegration briefings.  

FMLA also includes a special leave entitlement that permits eligible employees 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 has a serious injury or illness incurred in the line of duty on active duty that may render the servicemember medically unfit to perform his or her duties for which the servicemember is undergoing medical treatment, recuperation, or therapy; or is in outpatient status; or is on the temporary disability retired list.

The appropriate forms for a qualifying exigency or serious injury or illness under military family leave of FMLA are below.  

Certification of Qualifying Exigency for Military Family Leave

Certification for Serious Injury or Illness of Covered Servicemember


Other Types of Leave

Other types of leave requests include further training/education in a related field and personal leaves of absence.  Approval is considered on a case-by-case basis.  In addition to submitting the district leave of absence form (see the link to this form above), documentation supporting the requested leave must be included with the request.

For questions regarding leave of absence information, please contact:

Judy Steinbaugh
Personnel Technician
BVSD Human Resources
6500  Arapahoe Road
Boulder, CO 80303
FAX  720-561-5098


Medical/Dental Insurance

Medical and dental insurance may be continued at your own expense during your leave of absence. If you are on Family and Medical Leave Act (FMLA), the district will continue your coverage for up to 12 weeks, but you must still pay for your dependents. If your leave extends longer than 12 weeks, you will have the option of continuing your health benefits at your own expense, making payments directly to BVSD, until you return to work.

If you are on a professional or personal leave, your coverage will end on the last day of the month on which your leave starts. You have the option of continuing your health benefits at your own expense, making payments to the district, until you return to work.

Insurance payments must be received by the Division of Human Resources by the 10th of each month. Reminders will not be sent and your insurance will be cancelled if payment is not received. Click here for a list of current insurance premiums.

If you are paying your insurance while on leave and decide to terminate your employment, you will have the option of continuing to pay for your coverage for an additional 18 months under COBRA. Click here for a current list of COBRA rates.

If you stop paying or cancel your insurance any time during your leave, remember that you must re-enroll onto the policy when you return to work. Coverage will not be reinstated automatically.

District Life Insurance/Long Term Disability Insurance

While employed by the district, you have a life insurance policy of $20,000. This may continue durig your leave at your own expense of $1.90 per month.

If your medical leave continues for an extended period of time, you may qualify for long term disability. You may ask Judy Steinbaugh or Susana Aguirre about the process, or you may read about it on our LTD web page.

PERA - Optional Life Insurance

If you wish to continue PERA life insurance during your leave, contact Payroll. If you let this coverage cease, you must reapply during PERA's open enrollment.

For questions about health benefits, please contact:

Susana Cole
Benefits Specialist
BVSD Human Resources
6500 Arapahoe Rd
Boulder, CO 80303