2861_204479282707_20211229_0000460367.pdf - NYL GBS Leave...

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NYL GBS Leave SolutionsClaims Service CenterP.O. Box 16163Pittsburgh, PA 15242-0791Stella Koshy4713 Jetty StOrlando, FL 32817
Page 1of 5© 2021, New York Life Insurance Company, New York, NY. All rights reserved. NEW YORK LIFE and theNew York Life box logo are registered trademarks of New York Life Insurance Company. New York LifeGroup Benefit Solutions products and services are provided by Life Insurance Company of North Americaand New York Life Group Insurance Company of NY, subsidiaries of New York Life Insurance Company.NYL GBS Leave SolutionsPhone: 800.852.0682Fax: 866.931.509512/29/2021FML Leave ID #: 204479282707Re: Acknowledgment of Request for Leave Eligibility Notice for Parent - Theankamma KoshyDear Stella Koshy,We received your leave of absence request for Family Health Condition.Your Eligibility StatusThe grid below provides a visual breakdown of your available leave plan(s) and the eligibilitystatus for each. If you have questions about your available leave plans, please give us a call at800.852.0682.PlanAbsence TypeFromThrough*EligibilityReasonFMLAContinuousLeave06/05/202207/04/2022Eligible-PendingDeterminationPLOAContinuousLeave06/05/202207/04/2022Eligible-PendingDetermination*If you did not know your leave end date when you filed your leave, the “Through” date listedabove is a default date.Please note that being eligible for leave does not mean that yourrequest is approved.PlanTime Used as of06/05/2022*Time Remaining as of06/05/2022*
Page 2of 5© 2021, New York Life Insurance Company, New York, NY. All rights reserved. NEW YORK LIFE and theNew York Life box logo are registered trademarks of New York Life Insurance Company. New York LifeGroup Benefit Solutions products and services are provided by Life Insurance Company of North Americaand New York Life Group Insurance Company of NY, subsidiaries of New York Life Insurance Company.FMLA0 hour(s) / 0 week(s)432 hour(s) / 12 week(s)*Time Used and Remaining are based on your work schedule at the time you filed your leave.This includes time used in this leave and any other leave within the current leave period. Thesereflect only the time reported to date and may be subject to change.AdventHealth’s Leave of Absence Policy allows an eligible team member to be absent fromwork for up to a total of 18 weeks in a rolling 12 month period when using any combination ofFMLA, company Medical Leave (MLOA) and company Extended Medical Leave (ELOA) for theteam member’s own serious health condition. This leave limitation may mean an adjustment inthe amount of ELOA you have available if you have taken a combination of both MLOA andFMLA leaves within the rolling 12-month period. New York Life Group Benefits Solutions assistsAdventHealth by tracking your time away from work under these leave programs. In the eventNew York Life Group Benefits Solutions shows time available under MLOA and/or ELOA whichexceeds 18 weeks total time away from work, AdventHealth reserves the right to issue a denialon use of further company leave.

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Term
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Tags
Leave, Family and Medical Leave Act of 1993, New York Life Insurance Company

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