leave bank. submitting a leave bank request provide employee with a leave bank information packet...
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Leave Bank
Submitting a Leave Bank Request
Provide Employee with a Leave Bank Information Packet which includes:Leave Bank Fact Sheet Leave Bank Request Form (MS 408)Medical Request Form (MS 402)HIPAA FormExamples of Medical Documentation
Submitting a Leave Bank Request
Leave Bank Request Form – Recent Revisions:
Divided into sectionsEmployee completes Section 1Leave Bank Coordinator completes
Section 2Appointing Authority/Designee
completes Section 3
Submitting a Leave Bank Request
Leave Bank Request Form – Section 2:
Last Day Worked: last day employee actually worked
Employee Needs – number of hours employee needs after all accrued leave is used minus any annual and sick leave employee earns during absence
Submitting a Leave Bank Request
Leave Bank Request Form - Section 2:
Can Agency accommodate a modified duty assignment?
Is employee on FMLA?Has employee been placed on one-day sick
leave restriction within the last two years?
Submitting a Leave Bank Request
Leave Bank Request Form - Section 2:
Has employee received disciplinary action within the last year?
What is employee’s last performance rating?
Is absence due to on-the-job injury?
Submitting a Leave Bank Request
Medical Request Form – Recent Revisions:
Date of SurgeryDate of HospitalizationAdditional space for modified duty information
Medical Documentation
Recent Revisions:
We are encouraging employees to submit
detailed medical information with the initial
request (rather than during appeal process)
In the past two years, 60% of Leave Bank
Requests that were denied initially were
approved on appeal because the employee
provided more detailed medical documentation.
Submitting Medical Documentation
Recent Revisions:
Employee may submit detailed medical
records to the agency or directly to DBM
If employee sends records to DBM, s/he
must still submit Leave Bank Request Form &
Medical Request form to the Agency
Submitting a Leave Bank Request
Leave Bank Requests can be submitted via fax, email or regular mail:
Fax: 410-333-5440
EMAIL: [email protected]
Address: Department of Budget and Management 301 West Preston Street, Room 508 Baltimore, MD 21201
Processing a Leave Bank Request
All requests must meet these Administrative requirements: Employee must have current Leave Bank
membership Employee must not have been placed on one-day
sick slip restriction within the last 2 calendar years Employee must not have received disciplinary
action within the last year Employee must have at least “Satisfactory” rating
on most recent Performance Evaluation
Processing a Leave Bank Request
If Fully Approved – only Agency is notified
If Partially Approved or Denied – Agency and employee are notified. Employee is notified of appeal rights and sent appeal forms
Processing a Leave Bank Request
If the request is denied for medical reasons, it was reviewed by State Medical Director and is denied because:
Insufficient Medical Documentation was submitted to support request or
It is unlikely employee will return to work
Membership
Membership is for two years:
Join within first 60 days of employment
The first time employee joins Leave Bank,
employee must wait 90-days before
requesting leave
Membership
Join during Health Benefits/Leave Bank “Open Enrollment” period:
Membership begins July 1 and expires June 30 two years later
Example: July 1, 2011 – June 30, 2013
Membership
Join by Forfeiting Leave:
- If employee forfeits 8 or more hours of annual and/or personal leave at end of calendar year, employee becomes Leave Bank member
Example: January 12, 2011 – January 11, 2013
Membership
To join/re-enroll Leave Bank, employee must complete Leave Bank Donation Form (MS-401):Initial: check if employee is joining for the
first timeRenewal: check if employee is renewing
membership Reinstatement: check if employee is
“Reinstated to State Service”
Contact Information:
Margaret Embardino, Director, Employee Medical Services Phone: 410-767-4483 Email:[email protected]
Lisa Waskiewicz, Coordinator, Leave Bank Phone: 410-767-1697 Email: [email protected]
Camilla Starkey, Administrative Specialist Phone: 410-767-4627Email: [email protected]