06. How do I know if I have a serious health condition or a family member has a serious health condition?

A serious health condition is an illness, injury, impairment, physical or mental condition that incapacitates you or a family member for 3 consecutive days or longer, and involves at least one of the following:

  • Hospital Care - Inpatient care (i.e., an overnight stay) in a hospital, hospice, or residential medical care facility, including any period of incapacity or subsequent treatment in connection with or consequent to such inpatient care.
  • Absence Plus Treatment - A period of incapacity of more than three consecutive calendar days including any subsequent treatment or period of incapacity relating to the same condition), that also involves:
    • Two or more treatments by a health care provider, by a nurse or physician’s assistant under direct supervision of a health care provider, or by a provider of health care services (e.g., physical therapist) under orders of, or on referral by, a health care provider; or
    • One treatment by a health care provider which results in a regimen of continuing treatment under the supervision of the health care provider.
  •  Pregnancy - Any period of incapacity due to pregnancy related disabilities, or for prenatal care.
  • Chronic Conditions Requiring Treatments - A chronic condition exists when the condition:
    • Requires periodic visits for treatment by a health care provider, or by a nurse or physician’s assistant under direct supervision of a health care provider
    • Continues over an extended period of time (including recurring episodes of a single underlying condition); and
    • May cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy).
  • Permanent Long-term Conditions Requiring Supervision - A permanent or long-term condition(s) requiring supervision is defined as a period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective. The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider. Examples include Alzheimer’s, a severe stroke, or the terminal stages of a disease.
  • Multiple Treatments (Non-Chronic Conditions) - Any period of absence to receive multiple treatments (including any period of recovery time) by a health care provider or by a provider of health care services under orders of, or on referral by, a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity of more than three consecutive calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy), and kidney disease (dialysis).

 Important definitions for understanding what qualifies as a Serious Health Condition:

  • Incapacity is the inability to work, attend school, or perform other regular daily activities due to a serious health condition or treatment for, or recovery from a serious health condition.
  • Treatment includes examinations to determine if a serious health condition exists and/or evaluations of the condition.  It does not include routine physical, eye or dental examinations.