Edit, Download, and Sign the FAQ on Leaves of Absence due to COVID-19
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How do I fill this out?
To fill this out, ensure you understand the different medical scenarios that require documentation. Gather all necessary medical documents as outlined. Follow the steps below for detailed instructions on each scenario.

How to fill out the FAQ on Leaves of Absence due to COVID-19?
1
Identify the medical scenario applicable to the employee.
2
Obtain the appropriate documentation from Kaiser Permanente.
3
Request additional documentation if needed through KP.org.
4
Submit the documentation to the employer.
5
Follow up if further information is required.
Who needs the FAQ on Leaves of Absence due to COVID-19?
1
Employees who are symptomatic and unable to work due to COVID-19 need this file for documentation.
2
Employees at risk due to preexisting conditions require this file for proof of their high-risk status.
3
Employees caring for sick relatives or high-risk family members need this file for relevant documentation.
4
Human resources departments need this file to understand employee leave and benefits scenarios related to COVID-19.
5
Disability providers require this file to approve COVID-19 related disability claims.
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What are the instructions for submitting this form?
Submit this form along with the necessary documentation through your employer's HR department. You can also fax the completed form to the HR department or submit it via their online submission platform. If physical submission is required, mail it to the employer's physical address.
What are the important dates for this form in 2024 and 2025?
For the years 2024 and 2025, note any guidance issued at the beginning of the year, along with any mid-year updates related to COVID-19 benefits and documentation requirements.

What is the purpose of this form?
This form is necessary to document various scenarios related to COVID-19 that impact employee work status. It helps employees and employers manage time off, benefits, and disability claims due to COVID-19. The accurate filling of this form ensures proper documentation and compliance with federal, state, and Kaiser Permanente guidelines.

Tell me about this form and its components and fields line-by-line.

- 1. Medical Scenario: Specify the medical situation affecting the employee.
- 2. Documentation: Mention the type of documentation required for the scenario.
- 3. How to Obtain Documentation: Instructions on how to get the necessary documentation.
- 4. Submission: Guidelines for submitting the documentation to employers or administrators.
What happens if I fail to submit this form?
Failure to submit this form can result in delays in receiving benefits and approval of leave. It can also impact compliance with state and employer requirements.
- Delayed Benefits: Processing of benefits may be delayed without proper documentation.
- Denial of Leave: Failure to submit can lead to denial of leave requests related to COVID-19.
- Compliance Issues: Non-compliance with employer and state guidelines may occur.
How do I know when to use this form?

- 1. Symptomatic Employee: When the employee has symptoms and cannot work.
- 2. High-Risk Employee: When the employee has preexisting conditions that put them at risk.
- 3. Exposure: When the employee needs to self-isolate due to exposure.
- 4. Caregiving: When the employee needs to care for a sick or high-risk family member.
- 5. State or Private Disability Claims: When filing a disability claim related to COVID-19.
Frequently Asked Questions
What scenarios require documentation for COVID-19?
Scenarios include being symptomatic, at risk due to preexisting conditions, exposure, caring for sick relatives, and needing medical leave documentation.
How can employees obtain documentation from Kaiser Permanente?
Employees can request documentation through an e-visit or secure messaging on KP.org.
Will Kaiser Permanente provide documentation for FFCRA coverage?
Yes, Kaiser Permanente provides COVID-19 documentation based on defined scenarios.
What documentation is needed for state or private disability claims?
Documentation provided will depend on whether the employee tested positive or is symptomatic.
How is COVID-19 treated as a disability?
Determination is based on positive tests or the extent of symptoms and a Work Status Form (WSF) is issued.
Can human resources receive sample documentation?
Kaiser Permanente only provides documentation to members; samples are not available.
How is COVID-19 treated as workers' compensation?
Compensability is determined by state workers' compensation acts and third-party administrators.
Are there changes to benefits for Kaiser Permanente members with COVID-19?
Cost sharing for screening, testing, and treatment is reduced to zero dollars, with some exceptions.
How can employees obtain information about disability benefits?
Employees should contact their employers and consult the California Employment Development Department if in California.
How are benefit changes due to employment status addressed?
Employers, payroll companies, or legal counsel should address these changes as policies vary and are frequently updated.
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