Medical Leave Checklist

This checklist is designed to support university faculty and staff in navigating the medical leave process. The resources below outline key documentation and important considerations related to requesting and managing a period of medical leave.

Required Forms

The following forms are required to initiate and process a medical leave request. Please review and complete all applicable documents to ensure timely review, approval and coordination of your leave.

• Medical Leave Request Form
• Certification of Health Care Provider Form
  • For self
  • For family member
• UT San Antonio Work Release (if out for a personal medical condition)

Benefits

Contact Benefits at 210-458-4250 to discuss how a period of medical leave may affect your current elected benefits.

Blue Cross Blue Shield of Texas

Contact Blue Cross Blue Shield of Texas to submit a short-term disability claim. To be eligible for short-term disability, you need to meet the 14-day elimination period and exhaust all available sick leave.

Parking Services

If you use payroll deduction to pay for your parking permit, the monthly deduction from your paycheck will continue during your leave, unless you return the permit to the Campus Services. You may contact them at 210-458-7275 to make arrangements.

Unpaid Leave for Full Calendar Month (if applicable)

When on an unpaid leave of absence for a full calendar month, you will not receive:

• Longevity pay
• State Service credit
• Leave accruals (sick/vacation) for that month

Holiday Pay

To be eligible for holiday pay while on medical leave, a benefits-eligible employee must be in a paid status before/after the holiday.