4. In § 146.117, revise paragraphs (a)(1), (a)(4), (b)(1), (b)(3), and example 2 in paragraph (b)(4), and add examples 3, 4, and 5 in paragraph (b)(4), to read as follows:
(a) In general. The rules of this part apply with respect to an individual on leave under the Family and Medical Leave Act of 1993 (29 U.S.C. 2601) (FMLA), and apply with respect to a dependent of such an individual, except to the extent otherwise provided in this section.
(b) Tolling of significant break in coverage during FMLA leave. In the case of an individual (or a dependent of the individual) who is covered under a group health plan, if the individual takes FMLA leave and does not continue group health coverage for any period of FMLA leave, that period is not taken into account in determining whether a significant break in coverage has occurred under § 146.113(b)(2)(iii).
(c) Application of certification provisions —(1) Timing of issuance of certificate —(i) In the case of an individual (or a dependent of the individual) who is covered under a group health plan, if the individual takes FMLA leave and the individual's group health coverage is terminated during FMLA leave, an automatic certificate must be provided in accordance with the timing rules set forth in § 146.115(a)(2)(ii)(B) (which generally require plans and issuers to provide certificates within a reasonable time after coverage ceases).
(ii) In the case of an individual (or a dependent of the individual) who is covered under a group health plan, if the individual takes FMLA leave and continues group health coverage for the period of FMLA leave, but then ceases coverage under the plan at the end of FMLA leave, an automatic certificate must be provided in accordance with the timing rules set forth in § 146.115(a)(2)(ii)(A) (which generally require plans and issuers to provide a certificate no later than the time a notice is required to be furnished for a qualifying event under a COBRA continuation provision).
(2) Demonstrating FMLA leave. (i) A plan or issuer is required to take into account all information about FMLA leave that it obtains or that is presented on behalf of an individual. A plan or issuer must treat the individual as having been on FMLA leave for a period if—
(A) The individual attests to the period of FMLA leave; and
(B) The individual cooperates with the plan's or issuer's efforts to verify the individual's FMLA leave.
(ii) Nothing in this section prevents a plan or issuer from modifying its initial determination of FMLA leave if it determines that the individual did not have the claimed FMLA leave, provided that the plan or issuer follows procedures for reconsideration similar to those set forth in § 146.111(f).
(d) Relationship to loss of eligibility special enrollment rules. In the case of an individual (or a dependent of the individual) who is covered under a group health plan and who takes FMLA leave, a loss of eligibility for coverage under § 146.117(a) occurs when the period of FMLA leave ends if—
(1) The individual's group health coverage is terminated at any time during FMLA leave; and
(2) The individual does not return to work for the employer at the end of FMLA leave.