AMAZON_START RICOH USA, INC. 5575 Venture Drive Unit A Parma, Ohio 44130 Attn: Ziping Liu 109 Spanish Oak Circle Lake Jackson, TX 77566 5004o00000P6YBCAA3
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April 20, 2022 Ziping Liu 109 Spanish Oak Circle Lake Jackson, TX 77566 USA Action Required: Your leave request Ziping Liu, Case 04100713 Ziping Liu, We have received your Leave request. Below you will find required next steps, your leave overview, pay information, and more. Submit required documentation by June 7, 2022 to avoid denial of benefits and leave. Required Next Steps 1. In order to qualify for pay during your leave, WA state requires you to apply for paid benefits through the state of WA at https://paidleave.wa.gov/apply-now/ or Phone: (833) 717-2273 2. After applying with your state, you must submit your state benefit decision letter to Amazon within 5 days of receipt. Submit your decision letter by replying directly to this email, on the Resources page at atoz.amazon.work, or via the Disability and Leave Services (DLS) Portal at dls.idp.amazon.corp.com (on the Amazon network). 3. Return the attached Physician’s Statement form or medical documentation supporting your leave request by June 7, 2022(unless previously provided). Submit documentation by replying directly to this email, on the Resources page at atoz.amazon.work, or via the DLS Portal at dls.idp.amazon.corp.com (on the Amazon network). 4. Contact us if any of the information you provided changes, such as your leave start or end dates. Your Leave Overview You requested time off from May 16, 2022 to May 16, 2022 due to your personal health condition. You expect to return to work on May 17, 2022. You are eligible for leave provided by the federal Family and Medical Leave Act (FMLA). If your leave is approved based on the paperwork you provide, it will be designated under FMLA. Your time off work will reduce your available leave balance under FMLA: o Your requested leave will use an estimated 8 hours of FMLA which leaves a remaining balance of 6 weeks 32 hours. This is an estimate and is subject to change if your leave dates change.
Pay Available During Leave Your Amazon leave is unpaid. As an employee working in WA, you may qualify for state benefits. To receive payment, you are required to apply through your state. You may be eligible for benefits through your state. If you’re eligible and approved, you’ll receive payment according to the state plan. For assistance applying for the state plan, review the “Applying for State Benefits” handout Important Information You Should Know We are reviewing the leave plans for which you are eligible. We will apply the best benefit for your leave and pay benefits. A DLS team member will review your case and get in touch with you via your preferred contact method. You can enter available Sick, Personal, Floating Holiday, and/or Vacation time off via your A to Z Employee Self Service (ESS) Portal via atoz.amazon.work or DLS Portal on the Amazon network ( https://dls.idp.amazon-corp.com.) Review the FAQs for information about when your benefits will begin, end, and how a leave of absence impacts your health benefits, pay and stocks, if applicable. You can review your leave information on Amazon A to Z. Log in via atoz.amazon.work or use the app. (download for Android or iOS). Note that it takes 24-48 hours for all systems to reflect your active status. Questions? Contact us by phone at 1-888-892-7180 Option 1 Ext.5105 or email at amazondls@amazon.com. Thank you, Amazon DLS
You are entitled to 12 weeks of unpaid leave in the 12-month period (26 weeks to care for a covered servicemember with a serious health condition), measured backward from the date of any FMLA usage (“rolling backward” calculation method).
Your Responsibilities Under the FMLA If required by Amazon, you must submit sufficient certification or documentation in a timely manner, or your leave may be delayed or denied. If your leave is delayed or denied, any absences may be subject to the attendance policy and could result in termination.
After we have obtained sufficient information to make a determination, we will notify you within five business days whether your leave will be designated as FMLA and count against your FMLA entitlement. If you have any questions, please contact the Disability and Leave Services (DLS) team at 1-888-892-7180, option 1. Representatives are available between 5:00 a.m. and 5:00 p.m. PST, Monday through Friday.
In general, to be eligible for FMLA you must have worked for an employer for at least 12 months, meet the hours of service requirement (1,250 hours) in the 12 months preceding the leave, and work at a site with at least 50 employees within 75 miles. You must also have FMLA entitlement available in the applicable 12-month period.
If your leave qualifies and is certified as FMLA, your absences will be designated as FMLA leave and will count against your FMLA entitlement.
Amazon 1/2 Revised December 2019
Your Rights Under the FMLA
You must make your share of any premium payments to maintain your health benefits. You have a minimum 30day grace period in which to make premium payments. If payment is not made timely, your group health insurance may be cancelled, provided we notify you in writing at least 15 days before the date that your health coverage will lapse, or, at our option, we may pay your share of the premiums during FMLA leave, and recover these payments from you upon your return to work. If you do not return to work, you may be required to reimburse Amazon for our share of health insurance premiums paid on your behalf during your FMLA leave. You may be required to provide Amazon with periodic reports of your status and intent to return to work. Generally, these updates will be required every 30 days, depending on the circumstances of your leave.
FMLA Rights & Responsibilities Notice
You are not required to use accrued paid time off during your unpaid FMLA leave. You may supplement your leave with paid time off, if applicable. Any applicable conditions related to the usage of paid time off, as set by Amazon, will apply. If paid time off is used, the absences will also be designated as FMLA and will count against your FMLA entitlement. If you do not meet the conditions or requirements for usage of paid time off, you remain entitled to unpaid FMLA leave. Your health benefits must be maintained during your FMLA leave, as if you continued to work. You must be reinstated to the same or an equivalent job with the same pay, benefits, and terms and conditions of employment on your return from FMLA-protected leave. (If your leave extends beyond the end of your FMLA entitlement, you do not have return rights under FMLA. Certain circumstances, such as a reduction in workforce or your position no longer exists, could also prevent your reinstatement.)
Amazon 2/2 Revised December 2019
In order to be eligible to take leave under the FMLA, an employee must:
FMLA Frequently Asked Questions
for the birth of a son or daughter, and to bond with the newborn child; for the placement with the employee of a child for adoption or foster care, and to bond with that child;
work for a covered employer; have worked 1,250 hours during the 12 months prior to the start of leave; work at a location where the employer has 50 or more employees within 75 miles; and have worked for the employer for 12 months. The 12 months of employment are not required to be consecutive in order for the employee to qualify for FMLA leave. In general, only employment within seven years is counted unless the break in service is (1) due to an employee’s fulfillment of military obligations, or (2) governed by a collective bargaining agreement or other written (2) agreement.
1. What is the Family and Medical Leave Act (FMLA)?
Leave to care for or bond with a newborn child or for a newly placed adopted or foster child may not be taken intermittently, per Amazon’s policy (FMLA for bonding can be taken in two segments), unless otherwise allowed by state/local law, and must conclude within 12 months after the birth or placement.
5. Does an employee have to take leave all at once under FMLA or can it be taken periodically or to reduce the employee’s schedule? When it is medically necessary, employees may take FMLA leave intermittently taking leave in separate blocks of time for a single qualifying reason, or on a reduced leave schedule reducing the employee’s usual weekly or daily work schedule. When leave is needed for planned medical treatment, the employee must make a reasonable effort to schedule treatment so as not to unduly disrupt the employer’s operation.
2. Who can take FMLA leave?
to care for an immediate family member (spouse, child, or parent but not a parent “in-law”) with a serious health condition;
4. Does Amazon allow FMLA leaves for domestic partners? Yes, Amazon allows FMLA leave to be used to care for a domestic partner in the same way leave can be used to care for a spouse.
A covered employer must grant an eligible employee up to a total of 12 workweeks of unpaid, job-protected leave in a 12 month period for one or more of the following reasons:
The Family and Medical Leave Act (FMLA) provides eligible employees up to 12 workweeks of unpaid leave a year for various family and medical reasons, and requires group health benefits to be maintained during the leave as if employees continued to work instead of taking leave. Employees are also entitled to return to their same or an equivalent job at the end of their FMLA leave. The FMLA also provides certain military family leave entitlements. Eligible employees may take FMLA leave for specified reasons related to certain military deployments of their family members. Additionally, they may take up to 26 weeks of FMLA leave in a single 12-month period to care for a covered servicemember with a serious injury or illness.
to take medical leave when the employee is unable to work because of a serious health condition; or for qualifying exigencies arising out of the fact that the employee’s spouse, son, daughter, or parent is on covered active duty or call to covered active duty status as a member of the National Guard, Reserves, or Regular Armed Forces. The FMLA also allows eligible employees to take up to 26 workweeks of unpaid, job-protected leave in a “single 12-month period” to care for a covered servicemember with a serious injury or illness.
3 When can an eligible employee use FMLA leave?
12. What happens if I am not able to return to work at the end of my approved FMLA leave?
While this document is intended to provide a summary of general information regarding FMLA leave, in the event of a conflict between this document and the governing documents for any such benefits or policy, the terms of such governing documents will control. Please note these FAQs pertain only to the FMLA. An employee may have greater leave rights under state and local law.
You should contact the LOAA team, by calling 1-888-892-7180, option 1. You may be eligible for other leave options, including state or local leave laws or Amazon LOA policies. You may also be entitled to an accommodation, including leave of absence as an accommodation, under the Americans with Disabilities Act (ADA) and/or other applicable laws.
Please contact MyLeave at 888-892-7180, option 1, if you have any questions about leave under state or local law.
FMLA runs concurrently with any short-term disability (STD) benefits for which you are approved. FMLA will run during the approved STD period, if applicable, until FMLA entitlement is exhausted. Your STD claim will remain open for as long as you meet the requirements of the STD policy.
After the LOAA team receives a completed certification, your leave will be approved or denied based on the information that was received. You will be notified of the decision. If your FMLA leave is denied, you may be eligible for other leave options, including state or local leave laws or Amazon LOA policies.
The most common serious health conditions that qualify for FMLA leave are: conditions requiring an overnight stay in a hospital or other medical care facility; conditions that incapacitate you or your family member (for example, unable to work or attend school) for more than three consecutive days and have ongoing medical treatment (either multiple appointments with a health care provider, or a single appointment and follow-up care such as prescription medication); chronic conditions that cause occasional periods when you or your family member are incapacitated and require treatment by a health care provider atleast twice a year; and pregnancy (including prenatal medical appointments, incapacity due to morning sickness, and medically required bed rest).
8. What is the process when I request an FMLA leave?
11. What happens if my FMLA request is denied?
6. What is a serious health condition under FMLA?
A covered employer is required to maintain group health insurance coverage, including family coverage, for an employee on FMLA leave on the same terms as if the employee continued to work. Where appropriate, arrangements will need to be made for employees taking unpaid FMLA leave to pay their share of health insurance premiums.
9. How long does it take the LOAA team to process an FMLA request?
After the LOAA team has sufficient information to determine whether your leave is FMLA-qualifying (for example, after your certification is received), you will be notified whether the leave will be designated as FMLA leave within five business days, absent extenuating circumstances.
An employer's obligation to maintain health benefits under FMLA stops if and when an employee informs the employer of an intent not to return to work at the end of the leave period, or if the employee fails to return to work when the FMLA leave entitlement is exhausted. The employer's obligation also stops if the employee's premium payment is more than 30 days late and the employer has given the employee written notice at least 15 days in advance advising that coverage will cease if payment is not received. In some circumstances, the employer may recover premiums it paid to maintain health insurance coverage for an employee who fails to return to work from FMLA leave.
You will be notified, in writing, including the reason your leave was not approved. You may be eligible for other leave options, including leave under state or local leave laws or Amazon LOA policies generally.
10. How does FMLA leave impact any disability claim that I might have?
Amazon may require that the need for leave for a serious health condition of the employee or the employee’s immediate family member be supported by a certification issued by a health care provider. Amazon may also require that the need for leave to care for a covered servicemember with a serious injury or illness or military qualifying exigency be supported by appropriate certification. The form must be submitted to the Leave of Absence and Accommodations (LOAA) team by the due date listed in your FMLA materials. If the certification is incomplete or insufficient, you will be notified, in writing that includes what additional information is required, and you will be given additional time to cure the deficiency. If you provide authorization/release, the LOAA team will also make attempts to clarify the information with the healthcare provider.
FMLA Frequently Asked Questions
7. What happens to my health benefits while I am out on FMLA leave?
U.S. Guide to Benefits and Compensation During Leave of Absence (LOA) Revised December 2021
What’s Inside 1. Overview 2. Medical-Related Benefits General Information Changes to Benefits Related to Qualifying Events COBRA Coverage: Medical, Dental, and Vision Coverage Basic Life and Accidental Death and Dismemberment (AD&D) Insurance (company-paid) Supplemental Life Insurance or Supplemental AD&D Insurance 3. Bonuses, Stock & 401(k) Benefits, PTO, DSPP Sign-On Bonus PTO, Vacation, and Attendance Policies , Suspension of Vesting and Cancellation , 401(k) Account and 401(k) Loans, Direct Stock Purchase Plan (DSPP) 4. Return to Work Position Reinstatement Reasonable Accommodation 5. Important Provider/Contact Information
Overview This guide will help you understand Amazon leave policies and how your leave may affect employment and benefits. This guide provides only a summary of Amazon’s leave policies. It is your responsibility to review the complete policy or policies related to the type(s) of leave you are taking. Leave policies are available on Inside Amazon and can also be obtained by calling Disability and Leave Services (DLS) at 1-888-892-7180 (Option 1, option 1 again). In the event of a conflict between this guide and the applicable leave policy, the terms of the policy will prevail. Please contact DLS if you have questions about your leave of absence. This guide is also available on Inside Amazon and on Amazon Benefits: benefits.amazon.com (on the network) amazon.ehr.com (off the network)
General Information Company-funded medical benefits may end based upon your leave type. If this occurs, you will have the option to continue benefits at your own expense (see section below on COBRA coverage).
Short-Term Disability: Coverage will continue while on an approved Short-Term Disability (STD) claim. Coverage ends the first of the month following end of STD approval or 26 weeks, whichever occurs first. If your employment ends during STD, your benefit coverage may end.
Provider/Contact: Benefits Service Center 1-866-644-2696
Note: In-house seasonal associates and part-time operations employees scheduled for 20-29 hours (Class M and Class Q) are ineligible for leave under Amazon leave policies. However, they may be eligible for leave under the Family and Medical Leave Act, leave as an accommodation under the Americans with Disabilities Act, or leave under an applicable state or local law. Seasonal and part-time associates should contact DLS at 1-888-892-7180 (Option 1) to determine how leave will be impact their benefits.
When approved for Short Term Disability (STD) (including Pre-Partum or Post-Partum) as part of your LOA, or Paid Parental Leave, any deductions for benefits will continue and be taken from your STD or Paid Parental Leave benefit.
State or Municipal Specific Leaves: Coverage will be maintained as specified by regulation. Contact DLS at 1-888-892-7180 (Option 1) for more information.
Family & Medical Leave Act (FMLA) Leave: Coverage ends the first of the month following 12 weeks of leave in a 12month period (26 weeks for FMLA military caregiver leave or combination of military caregiver and other FMLA-qualifying leave).
If you have any questions about coverage during combined leaves, contact DLS at 1-888-892-7180 (Option 1).
When you return to work, your benefit elections that had been in effect prior to your leave will automatically be reinstated effective the date of your return, unless you have elected to make changes while you were on leave during open enrollment or due to a qualifying event. Contact the Benefits Service Center within 60 days of your qualifying event or within 30 days of your return to work if you decide you no longer want benefits coverage.
If and when you stop receiving an Amazon paycheck while on leave (whether for working, paid time off, vacation, STD or Paid Parental Leave), you will be financially responsible for any continued premiums for medical coverage. During any unpaid leave, Amazon will pay premiums on your behalf, but you must repay these amounts when leave ends. When you return to work, benefit deductions will resume, with one additional deduction occurring each pay period until the amounts owed are repaid, as permitted by law. Please contact the Employee Resource Center (ERC) for more information about payroll deductions.
Pre- or Post-Partum Leave: Coverage will be maintained while on approved Parental Leave, and ends the first of the month following the end of leave Ramp Back: Coverage will be maintained at the full-time rate while on Ramp Back.
Personal Leave: Coverage ends the first of the month following 12 weeks of leave, unless Personal Leave immediately follows another leave. Military Leave: Coverage ends the first of the month following 12 weeks of leave.
Medical-Related Benefits
If you combine different leave types, coverage may end sooner than indicated below. For example, if you take 12 weeks of FMLA leave followed by 12 weeks of Medical Leave or Personal Leave, coverage will cease at the end of the FMLA period.
Non-FMLA Medical Leave of Absence: Coverage ends the first of the month following 12 weeks of leave in a 12-month period, unless Non-FMLA Medical Leave immediately follows another leave.
You may be eligible to convert your Supplemental Life Insurance (employee, spouse/domestic partner, and child) coverage to an individual policy within 60 days of your coverage ending. You may also have the option to convert or port your supplemental life insurance coverage to an individual policy if you are under age 70. Call Prudential within 60 days of your coverage ending.
Did you have a Qualified Status Change like Adoption or the birth of a child? Be sure to add coverage within 60 days of the Qualifying Event! If you miss the deadline, you will not have the opportunity to make changes until the next Open Enrollment Period unless you have another qualifying event.
Call a Care Partner at 1-833-721-2323 or register at ResourcesForLiving.com/Amazon.
COBRA Coverage: Medical, Dental, and Vision Coverage
If you are approved for the Amazon short-term disability (STD) or long-term disability (LTD) Plan; your employer paid basic life and AD&D insurance coverage will continue and coverage will be based on your fulltime salary as of your last day worked.
You may not continue Basic AD&D coverage. If you choose to return with a “ramp back” schedule under the Ramp Back Policy, your Life and AD&D Insurance coverages are based on your full-time salary.
*Qualifying events include birth or adoption of a child, marriage, divorce, gaining or losing group health coverage, death of dependent, etc.
Supplemental Life Insurance or Supplemental AD&D Insurance
You may be eligible to convert your Basic Life Insurance coverage to an individual policy within 60 days of your coverage ending. Prudential will mail out a conversion packet to your address on file if you are eligible within 60 days of your coverage ending.
In the event of an employee death, any enrolled dependents will receive the employee’s Amazon medical, dental and vision coverage at no cost for three months. After three months, dependents can enroll in COBRA.
If your company-funded coverage ends, you and your covered dependents will be offered the option to continue your Medical, Dental, Vision and/or Health Care FSA coverage by electing and paying the full premium through COBRA.
A COBRA packet will be mailed to your mailing address in PeoplePortal. Generally, you have 60 days from the date your benefits end to enroll in COBRA.
Basic Life and Accidental Death and Dismemberment (AD&D) Insurance (company-paid)
Changes to Benefits Related to Qualifying Events*
If you experience a qualifying event* while on a benefits-eligible leave of absence, you have 60 days from the event date to make changes to your benefit elections. Any change must be consistent with your qualifying event. Call the Benefits Service Center.
You may not continue Supplemental AD&D coverage. If you are approved for the Amazon short-term or long-term disability plan; your supplemental life and/or AD&D insurance coverage will continue.
Resources for Living Resources for Living is mental health and wellness support available 24/7 to you at no cost. You, your family, and all members of your household have access to three free phone, video, or text therapy sessions per person, per issue, per year. You can also download the myStrength app (use access code: Amazon) for self-serve tools to manage stress, anxiety, depression, relationships, parenting and more.
PTO and Vacation Accrual Please review the policy that applies to your leave type(s) for information about accrual of Paid Time Off and Vacation Time during leave.
Bonuses, PTO, Stock & 401(k) Benefits, DSPP Sign-On Bonus
PTO
Except as stated above, Sign-on bonus payment(s) will be suspended (placed on hold) until your return to active employment status Provider/Contact: ERC 1-888-892-7180 Policies and Vacation Use During LOA
This section applies to associates who were granted sign-on bonuses that have not been fully paid out at the time leave starts.
If you return on a part-time basis, sign-on bonus payments may be pro-rated.
If you chose Ramp Back, your sign-on bonus will be pro-rated based on the Ramp Back percentage you elect. The sign-on bonus payout period will be extended by the pro-rated time of Ramp Back not worked.
PTO, Vacation, and Attendance
Attendance
If you will be on unpaid leave or partially paid leave (such as short-term disability leave), you may elect to have PTO apply during leave by notifying DLS. Policies
If you use paid time off (PTO) during your leave, you will continue to receive scheduled sign-on bonus payment(s) while you are on PTO. If you are taking Military Leave, Pre-Partum Leave or Post-Partum Leave, your sign-on bonus will continue to pay out and will not be suspended.
Employees in some lines of business are subject to attendance policies. If you apply for leave and miss work before your leave is approved, and your request is denied for any reason (e.g., ineligible, lack of certification, etc.), your absences could be subject to the applicable attendance policy. For example, under the North American Customer Fulfillment (NACF) Attendance Policy, the time may count against your Unpaid Time Off (UPT) balance.
FMLA*,
FMLA*,
FMLA*,
Personal Leave Unpaid Suspension starts on 1st day If PLOA exceeds 3 months Yes Personal Leave Using PTO No suspension during PTO period If PLOA exceeds 3 months If PLOA exceeds 3 months employee’s own illness Paid by STD plan Suspension starts on 183rd day If combination of LOA exceeds 1 year If leave exceeds 182 days employee’s own illness Using PTO No suspension during PTO period If combination of LOA exceeds 1 year If combination of LOA exceeds 1 year employee’s own illness Unpaid Suspension starts on 183rd day If combination of LOA exceeds 1 year If leave exceeds 182 days Amazon Medical Leave, employee’s own illness Paid by STD plan Suspension starts on 183rd day If combination of LOA exceeds 1 year If leave exceeds 182 days Amazon Medical Leave, employee’s own illness Using PTO No suspension during PTO period If combination of LOA exceeds 1 year If combination of LOA exceeds 1 year Amazon Medical Leave, employee’s own illness Unpaid Suspension starts on 183rd day If combination of LOA exceeds 1 year If leave exceeds 182 days ADA Leave as an Accommodation (LEA) )- employee’s own illness Paid by STD plan Suspension starts on 183rd day If combination of LOA exceeds 1 year If leave exceeds 182 days ADA Leave as an Accommodation (LEA) )- employee’s own illness Using PTO No suspension during PTO period If combination of LOA exceeds 1 year If combination of LOA exceeds 1 year ADA Leave as an Accommodation (LEA) )- employee’s own illness Unpaid Suspension starts on 183rd day If combination of LOA exceeds 1 year If leave exceeds 182 days
LOA Effect on Stock (RSU) Suspension and Cancellation of Vesting
Pregnancy (pre- and post-partum) Paid by STD plan No suspension If combination of LOA exceeds 1 year If combination of LOA exceeds 1 year Paid Parental Leave Paid No suspension If combination of LOA exceeds 1 year If combination of LOA exceeds 1 year
Vesting of your stock-based award may be suspended or your stock-based award may be cancelled due to a Leave of Absence. Suspension of stock-based award vesting will result in vesting dates changing upon your Return to Work by the number of days you were on leave, minus any applicable grace period noted below. Cancellation of stock- based awards means that the award will cancel and will not be reinstated upon return to work. The following chart outlines the impact that different leave of absences could have on stock-based award vesting schedules. Unless otherwise required by law or noted below, vesting of stockbased awards will adjusted as follows:
Leave Type Circumstance Suspension** Cancellation Compensation Impact***
Pay
RSU
FMLA*, other reasons (care of family, etc.) Using PTO No suspension during PTO period If combination of LOA exceeds 1 year If combination of LOA exceeds 1 year FMLA*, other reasons (care of family, etc.) Unpaid Suspension starts on 15th day If combination of LOA exceeds 1 year If leave exceeds 14 days
While on leave your stock vesting may show a placeholder year of 2099 or 2100, which will be updated upon your return from leave. When you return to active employment, your vesting schedule will be adjusted to reflect the number of days you were on leave (not including any period of PTO or applicable grace period).
While on Ramp Back, stock vesting will be pro-rated based on the Ramp Back option you have selected, and the remaining outstanding (unvested) stock-based awards (including RSUs) will be adjusted based on the number of days on Ramp Back.
Military Leave Using Military Differential Pay (MDP) No suspension No cancellation No impact Military Leave Using PTO No suspension No cancellation No impact Military Leave Unpaid No suspension No cancellation No impact US SILOA-ATA Leave Unpaid
** If you are on a leave of absence for which vesting is suspended and transition to another type of leave of absence, vesting will remain suspended even if suspension would otherwise start on the 15th day of this subsequent type of leave of absence.
Provider/Contact: 1-888-892-7180, option 1
Suspension starts on 1st day If combination of LOA exceeds 1 year Yes by any combination of FMLA, or state/local leave laws.
*Protected
***In some circumstances, if the vesting schedule is paused or suspended, the vesting of your unvested stock-based awards may be moved into a new calendar year (January December) or compensation year (April March). Future annual compensation reviews will be based on the new vesting schedule that is established when you return from leave. Talk with your HRBP to understand how this might impact your annual compensation.
Provider/Contact: Fidelity 1-800-835-5095
DSPP deductions do not change while on LOA. If you receive a paycheck and have net pay, you will have a DSPP deduction and purchase shares. If you have no pay while on LOA, then no deductions will be taken and no shares will be purchased.
New 401(k) loans cannot be issued while you are on LOA.
Direct Stock Purchase Plan (DSPP) DSPP Deductions
During LOA
If Personal Leave exceeds 3 months, all of your outstanding (unvested) stock-based awards will be cancelled Stock-based awards will be cancelled it you are employed by any non-Amazon entity during Personal Leave.
While you are on leave, 401(k) deductions will be taken from eligible Amazon pay (note that STD benefit payments other than PrePartum and Post-Partum are not eligible pay).
Cancellation of Stock-Based Awards
For questions about stock during a leave of absence, call DLS at 1-888-892-7180, option 1 401(k) Account and 401(k) Loans
If collective leave time, together with other leaves of absence (other than military leave), including any paid personal time and vacation applied during the leaves, exceeds one continuous year, all of your outstanding stock-based awards will be cancelled on the first anniversary of the start date of the first leave.
Your Amazon 401(k) Savings Plan balance will remain invested while you are on leave, and you will continue to have the ability to access your account and change your investments.
If you have a 401(k) loan outstanding, loan payments will be withheld from your STD, Pre-Partum, Post-Partum or Paid Parental Leave benefit payments and processed into your 401(k) account to continue repayment of your loan. Please see the 401(k) Plan Loan Policy on Inside Amazon for additional information on paid, unpaid or military leaves of absence.
Reasonable Accommodation
While on a LOA, your employment with Amazon is maintained, but reinstatement to your position is not guaranteed unless required by applicable law. Please review the policy or policies applicable to your leave type(s) for complete information about reinstatement following leave.
Absent certain exceptions (e.g., your position was eliminated during leave), reinstatement typically occurs as follows: FMLA, Pre-Partum, Post-Partum, Paid Parental Leave: Reinstatement to your prior position (or equivalent) is offered if you return to work on or before the end date of your approved leave. Personal Leave: Reinstatement to prior or equivalent position is generally offered, but not guaranteed. Amazon has discretion to fill your position while you are on Personal Leave, and if this occurs, your employment will be terminated when your leave ends. Military Leave: Reinstatement to prior position, or position that you would have been in had you not taken military leave, is offered. Non-FMLA Medical Leave of Absence: Whether you will be reinstated, and to what position, will be determined on a caseby- case basis and consistent with applicable law
If you will require reasonable accommodation due to a disability or medical condition when you return to work, please contact 1-888892-7180, (Option 1), within two weeks prior to your return date if possible. Amazon will engage in an interactive process with you to discuss how to support your limitations or restrictions and any specific accommodation details. More information on the Amazon’s reasonable accommodation policy is available at Inside Amazon.
Provider/Contact: Your HR Partner
Return to Work Position Reinstatement
Important Provider Contact Information Provider Contact Information Availability Disability and Leave Services (DLS) 1-888-892-7180, option 1, https://dls.idp.amazon-corp.com (on the network), or via A to Z under the Time-Off tab Intake (new cases): 24/7 Case Management: Monday Friday, 5 a.m. 5 p.m. PT Employee Resource Center (ERC) 1-888-892-7180 24/7 Benefits Service Center 1-866-644-2696 Monday Friday 5 a.m. 6 p.m. PT Amazon Benefits benefits.amazon.com (on the network) amazon.ehr.com (off the network) 24/7 Amazon Stock Portal amazonstock.com (on the network), or via A to Z under Resources tab 24/7 Fidelity Stock Plan 1-800-544-9354 www.netbenefits.com Monday Friday, 8:30-8:30 EST Morgan Stanley Stock Plan Connect 1-833-721-2323 stockplanconnect.com Monday Friday, 5 a.m. 5 p.m. PT Resources for Living (Employee Assistance Program) 1-833-721-2323 resourcesforliving.com/amazon 24/7 Aetna 1-866-574-9124 amazon.aetna.com 24/7 Premera Blue Cross 1-877-995-2696 premera.com/amazon 24/7 Kaiser Permanente 1-855-249-5008 my.kp.org/amazon 24/7 Express-Scripts 1-844-626-9387 Express scripts.com/amazon 24/7 RxAdvance (CT, DE, FL, IN, KS, NC, NV, PA) 1-800-991-3164 amazon.rxacloud.com 24/7
Delta Dental 1-844-466-8847 Deltadentalwa.com Monday Friday 7 a.m. 5 p.m. PT VSP 1-844-401-5670 vsp.com Monday Friday 5 a.m. to 6 p.m., Pacific Time Saturday & Sunday 7 a.m. to 5 p.m., Pacific Time Prudential 1-855-778-3291 Monday Friday, 5 a.m. 5 p.m. PT Fidelity HSA 1-800-835-5095 netbenefits.com/amazon Monday Friday 8:30 a.m. EST 12 a.m. EST Optum Financial (FSA) 1-855-609-8616 Connectyourcare.com 24/7 COBRA Connect 1-877-29-COBRA (26272) cobra.ehr.com Monday Friday, 6 a.m. 4 p.m. PT Grand Rounds 1-800-510-7990 grandrounds.com/amazon 24/7 My 401(k) Fidelity 1-800-835-5095 (Amazon 401(k) Plan number: 093958) Monday Friday, 8:30 a.m. 8:30 p.m. PT Computershare 1-866-239-0172 computershare.com/amazon Monday Friday, 12 a.m. 6 p.m. PT CastLight 1-800536-8707 Monday Friday, 5 a.m. 6 p.m. PT
Return Fax Cover Sheet Return Fax Number: 1-855-579-1799 Employee: Phone: Case Number: Comments: If you have any questions or concerns, please contact Disability & Leave Services (DLS) by emailing amazondls@amazon.com or calling (888)892-7180. NOTE: The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers from requesting or requiring genetic information of employees or their family members. Please do not provide any genetic information when responding to this request for medical information. Genetic information is defined in 29 CFR. § 1635.3. Do not provide information about genetic tests, as defined in 29 C.F.R. § 1635.3(f), genetic services, as defined in 29 C.F.R. § 1635.3(e), or the manifestation of disease or disorder in the employee’s family members, 29 C.F.R. § 1635.3(b).
Health Care Provider Form - Own Health Condition Return this form by fax to 1-855-579-1799 or by email to amazondls@amazon.com. Instructions for Healthcare Provider: Complete Sections A-D as applicable with the medical facts to support this employee’s claim for time off under the Family and Medical Leave Act (FMLA), applicable state/local leaves, and/or company leave options. Please indicate “not applicable” in any section where the question is not relevant to the condition, or where the information would not be relevant to our evaluation of your patient’s need for leave. Employee Name: Ziping Liu Employee Date of Birth: January 28, 1995 Employee Job Title: Software Development Engineer Case Number: 04100713 Requested Leave Start Date: May 16, 2022 Requested Return To Work: May 17, 2022 Section A: Patient’s Serious Health Condition (to be completed by the Health Care Provider) A1. Does/did the patient require time away from work due to their health condition? Yes No A2. Serious Health Condition (Select all that apply.) Hospital Care (an overnight stay in a hospital, hospice or residential care facility, and incapacity related to this stay, such as recovery at home following discharge) Yes, inpatient (overnight stay); Admit date: _____/_____/_____ Discharge date: _____/_____/_____ Yes, outpatient surgery, diagnostic or treatment unit (not emergency room); Service date: _____/_____/_____ Incapacity + Treatment (treatment two or more times following a period of incapacity of at least three consecutive full calendar days) Pregnancy/Birth (any period of incapacity due to pregnancy or recovery from childbirth, including pre- and post-natal care) Yes, with due date _____/_____/_____ Vaginal delivery Cesarean Yes, pregnancy loss; loss date _____/_____/_____ at week of gestation Chronic Condition (a condition requiring regular provider visits/treatment, continuing for an extended period of time) Permanent or Long-term Condition (a period of incapacity or treatment due to a long-term condition under the continuing supervision of a provider) Multiple Treatments for a Non-Chronic Condition (absence to receive multiple treatments, or for a condition that would result in incapacity if not treated) Other explain: A4. Was the injury/illness sustained while the patient was performing their job? Yes No Form continues on next page.
Section B: Leave Request Information (to be completed by the Health Care Provider) B1. What is the estimated end date of the condition? _____/_____/_____ or Greater than 1 year Permanent B2. First visit date: ____/____/____ Last visit date: ____/____/____ Next office visit date: ____/____/____ B3. Select the type(s) of leave that the patient needs. Continuous Leave (one single uninterrupted absence from work) Leave Start Date: _____/_____/_____ Intermittent Leave (multiple absences from work for the same disability or impairment over a period of time, provide best estimate if unknown) First Date of Absence: _____/_____/____ Certification End Date: _____/_____/_____ number of absences per day week month year number of hours or days (circle one) per absence Section C: Return to Work Planning (to be completed by the Healthcare Provider) C1. Per your assessment, is your patient fit to return to work? Yes, fit to return full duty with no restrictions on _____/_____/_____ Yes, fit to return full duty with restrictions on _____/_____/_____ (Amazon may request additional information.) If yes, is there an accommodation that would enable the employee to return? No, cannot return to work at this time (Amazon will provide a separate form for return to work planning.) Section D: Certification by the Provider (to be completed by Health Care Provider) I certify that the information contained on this form and submitted with this form is true and correct. Provider’s Name and Credentials (MD, DO, etc.) Type of Practice Telephone Number Office Address (Street, City, State, Zip Code) Office Hours Fax Number / / Provider’s Signature Date The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. “Genetic information,” as defined by GINA, includes an individual’s family medical history, the results of an individual or an individual’s family members’ genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.
Family and Medical Leave Act (FMLA)
Serious Health Condition Definitions
Serious Health Condition is an illness, injury, impairment, or physical or mental condition that involves any of the following criteria.
Absence Plus Treatment is a period of more than three full consecutive calendar days of incapacity (including any subsequent treatment or period of incapacity related to the same condition) that also involves either: Treatment two or more times by a health care provider. For all employees except in California, both treatments must involve an in- person visit and occur within 30 days of the first day of incapacity, and the first visit must occur within seven days of the first day of incapacity.
Hospital Care is inpatient care (an overnight stay) in a hospital, hospice, or residential medical care facility, including any period of incapacity or subsequent treatment related to that inpatient care.
Multiple Treatments for a Non-Chronic Condition is any absence required to receive multiple treatments (including any related recovery periods) for either: Restorative surgery after an accident or other injury. A condition that could result in more than three consecutive calendar days of incapacity without medical intervention or treatment.
Treatment by a health care provider on at least one occasion that results in a regimen of continuing treatment under a health care provider’s supervision. For all employees except in California, the treatment must involve an in-person visit that occurs within seven days of the first day of incapacity.
Pregnancy/Birth is any period of incapacity due to pregnancy or recovery from childbirth, including pre- and post-natal care.
Permanent or Long-Term Condition is a period of incapacity or treatment due to a long-term condition under the continuing supervision of a provider.
Chronic Condition is a condition requiring regular provider visits/treatment, continuing for an extended period of time.
The information obtained by use of this Authorization will be used to evaluate and administer the Patient’s claim for benefits under the employer’s plan for short-term disability benefits or long-term disability benefits insured by Aetna or The Hartford, to administer the Patient’s claim for workers’ compensation benefits, and/or a request for leave of absence or related benefits. Such information is referred to in the Patient Authorization as “My Information.”
PATIENT AUTHORIZATION
Information covered by this authorization: Any and all medical (but not genetic) information or records, including X-ray films, prescription histories, medical histories, physical, mental or diagnostic examinations, and treatment notes, and including information regarding HIV/AIDS, communicable diseases, alcohol or drug abuse, and mental health, as such information may be related to the Patient’s claim for benefits; work information and history, including job duties, earnings and personnel records, and client lists; information on any insurance coverage and claims filed, including all records and information related to such coverage and claims; Social Security benefits information, including monthly benefit amounts, monthly payment amounts, entitlement dates, and information from my Master Beneficiary Record.
To: Any health care provider, Pharmacy Benefit Manager, employer, benefit plan, insurer, financial institution, consumer reporting agency, educational institution, or federal, state, or local government agency, including the Social Security Administration and Veterans’ Administration. By signing the Patient Authorization below, your Patient has authorized you to disclose to Amazon, Aetna, The Hartford, WorkCare, or Sedgwick CMS a complete copy of any and all personal or privileged information, records, or documents described herein.
Instructions for
Employee Name: Ziping Liu Employee Date of Birth: January 28, 1995 Employee ID: 106181148
This Authorization is being provided so that Amazon and any of its parents, affiliates, subsidiaries, and/or third-party contractors; Aetna Inc. (Aetna), and any of their parents, affiliates, subsidiaries, and/or third-party contractors; The Hartford, and any of their parents, affiliates, subsidiaries, and/or third-party contractors; Amazon Corporate LLC (together with any of its Affiliates or Subsidiaries (Amazon); WorkCare, and any of its parents, affiliates, subsidiaries, and/or third-party contractors; and/or Sedgwick Claims Management Services, Inc. (Sedgwick CMS) can obtain the necessary information to adjudicate a claim for disability or workers’ compensation benefits, or a request for leave of absence or related benefits, initiated by or on behalf of the Patient identified above (“Patient”). Once this Authorization is completed and signed by the Patient (or Patient’s guardian) whose personal health information is to be disclosed, the health care provider should retain the original for its records and provide a copy of the Authorization to the Patient.
Patient can submit completed document via the DLS Portal, by faxing to 1-855-579-1799, by emailing amazondls@amazon.com, or by mail to Amazon Disability & Leave Services (DLS), PO Box # 81103 Address: 5801 Postal Road, Cleveland, Ohio 44181.
I authorize Amazon, Aetna, The Hartford, WorkCare, or Sedgwick CMS to use or disclose My Information as necessary to administer my claim for short-term disability benefits and/or workers’ compensation benefits and/or leave of absence or related benefits. I also authorize Amazon, Aetna, The Hartford, WorkCare, or Sedgwick CMS to disclose My Information as follows: (i) to Amazon for (a) functions related to accommodating my medical restrictions or limitations;
Authorization to Obtain and Disclose Information Employee: Complete and return to Amazon Disability & Leave Services (DLS). Return the form: Upload the completed form to the DLS Portal, found on the Amazon AtoZ Resources page or at dls.idp.amazon-corp.com (while on the Amazon network). You can also email to amazondls@amazon.com or fax to 1-855-579-1799.
Important Information for Your Health Care Provider About GINA
Note to employee/beneficiary:
(b) federal or state Family & Medical Leave Act administration; (c) administration of related leave or benefits claims;(d)fulfilling fiduciary obligations under my benefit plan or (e) responding to legal claims against Amazon or its agent; (ii) to the administrator or other service providers of Amazon’s benefit plan or other benefit plans of my employer for plan-related functions; (iii) to any system used for claims processing or insurance broker to carry out functions related to my benefit plan or claim; (iv) to any health care professional who has treated or evaluated me or who may do so; (v) to other persons or entities performing business or legal services related my claim or to other benefits for which I may be eligible in the future; (vi) as may be lawfully required; (vii) as I may further authorize; or (viii) as necessary to prevent or to detect perpetration of a fraud in connection with my application for benefits. I authorize the disclosure of my personal and medical information as described above. I understand that this authorization is voluntary. I understand that information disclosed pursuant to this Authorization may be subject to redisclosure by the recipient as permitted by applicable law or my further authorization. I understand that I have the right to fully or partially revoke this Authorization for future disclosures from Amazon, Aetna, WorkCare, or Sedgwick CMS may make, unless they have taken action in reliance upon this Authorization. If I decide to fully or partially revoke my Authorization, I must revoke do so in writing directly to Amazon, specifying whether I wish to fully revoke my authorization, or, if I wish to partially revoke my authorization, providing a description of the information and/or purposes for which I am withdrawing my authorization. I understand that my medical treatment, payment for medical benefits, or enrollment/eligibility for leave benefits cannot be conditioned on my allowing Amazon, Aetna, the Hartford, WorkCare, or Sedgwick CMS to re-disclose My Information and that I may fully or partially revoke my authorization for re-disclosure at any time.
In order to be considered for short-term disability or workers’ compensation benefits, you must authorize disclosure of personal and medical information as needed to determine whether you qualify for those benefits. If signed, this form would also authorize further disclosure of your information in order to expedite consideration of your eligibility for additional benefits in the future. Such additional benefits might include long-term disability benefits, vocational rehabilitation services, and payment of life insurance premium while you are on leave. You are not required to authorize disclosure or re-disclosure of your personal or medical information for such additional purposes. If you do not want this release to authorize such additional disclosure, please contact DLS at 1-888-892-7180.
Signature of Patient or Guardian Relationship to Patient (if signed by guardian) Date Signed
The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. "Genetic Information" as defined by GINA includes an individual's family medical history, the results of an individual's or family member's genetic tests, the fact that an individual or an individual's family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual's family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.
This Authorization expires two years from the date listed below or earlier as required by law, or upon my revocation, if earlier, but will not exceed the term of my coverage of the policy or benefit plan. I understand that I am entitled to receive a copy of this Authorization upon request. A photocopy or facsimile of this Authorization shall be as valid as the original. If there is a conflict between a prior request for restriction on the disclosure of My Information and this Authorization, this Authorization will control.
Paid Family and Medical Leave Statement of Employee Rights You may qualify for Paid Family and Medical Leave As of Jan. 1, 2020, Washington employees who have worked 820 hours or more in the qualifying period and experience(d) a qualifying event have access to Paid Family and Medical Leave. Employees who have missed work due to family or medical reasons may be eligible for paid family or medical leave for the following qualifications: Care for and bond with a child younger than 18 following birth or placement Care for yourself or a family member experiencing a serious health condition Certain military-connected events. Paid Family and Medical Leave requires that you give your employer(s) written notice at least 30 days in advance of when you plan to take leave. However, if the reason you need leave was not foreseeable, you may notify your employer(s) as soon as possible. The Paid Family and Medical Leave Benefit Guide provides information on how to apply for benefits and submit weekly claims. It also explains your rights and responsibilities under the law. Download the guide at www.paidleave.wa.gov/benefit-guide. For more information about how to apply, contact us at 833-717-2273 or visit www.paidleave.wa.gov. Important information for when you apply Employer UBI #: 602-201-545 This employer offers supplemental benefits: Yes, which includes: Short-Term Disability (STD), Pre-Partum Disability Leave, Post-Partum Disability Leave, and Parental Leave. Paid Time Off, Vacation and Sick Time are not offered as supplemental benefits to the benefits from the state. Note: Except during the waiting week, employees cannot use employer provided paid time off at the same time as Paid Family and Medical Leave, unless the employer chooses to offer a “supplemental benefit.” Supplemental benefits can be used along with Paid Family and Medical Leave to provide additional pay while an employee receives partial wage replacement through Paid Leave benefits. Employees may accept or reject supplemental benefit payments. EMPLOYER NOTICE TO EMPLOYEE UPDATED NOVEMBER 2019 Page 1 of 1
