Stephanie Haber
/ Categories: Benefits, Caregiver Leave

PFL for Caregiving

October 5, 2017

PFL Caring

Paid Family Leave Qualifying Events: Caregiving

When a close family member becomes seriously ill or injured, the stress of caring for them can greatly impact your job — as well as your life. Finding time to schedule doctor’s appointments, managing medication schedules, and ensuring that your loved one is comfortable and taken care of can be next to impossible while also maintaining a full-time job. Taking dedicated time to care for a loved one is important to the wellbeing of everyone involved. And, luckily, Paid Family Leave (PFL) is coming to New York.

To help you understand how Paid Family Leave works when caring for an ill family member, we’ve broken out the most important features of the program below.

Benefit Details: What You Get with PFL

Starting in January 2018, PFL caregiving benefits will allow eligible employees time they need to care for their family members with serious medical conditions. With PFL, you’ll be able to take up to 8 weeks during a 52-week period in 2018 to care for your ill family members while receiving up to 50% of your salary, capped at 50% of the New York State Average Weekly Wage (NYSAWW). This is slated to increase each year until it hits the maximum of 67% of your salary, capped at 67% of the NYSAWW* and 12 weeks of leave time in 2021. Paid Family Leave also guarantees that your employment position — or one comparable in pay and benefits — will be waiting for you when you return, and that you cannot be terminated for taking time off to care for your family member. You will also still receive your regular health insurance benefits, which are protected under PFL. Your employer is required to maintain your health insurance as if you were still working regularly (but you’re still responsible for paying your share of the premium while on leave).

*Current NYSAWW is $ 1,305.92 as of March 31, 2017. NY Department of Labor releases the updated NYSAWW every March 31.)

How You Can Use Paid Family Leave Caregiver Benefits

Being sidelined by the common cold doesn’t qualify for Paid Family Leave. Your family member must be unable to go to work or school, do regular daily activities, or be otherwise incapacitated for at least 4 consecutive days by a serious medical condition.  This includes:

  • at least 2 doctor treatments,
  • or 1 doctor treatment with a doctor-supervised regimen thereafter.
     

PFL regulations have very specific definitions of what is recognized as a serious health condition, such as:

  • An illness, injury, impairment, or physical or mental condition that involves specialized care.
  • Any of the above that requires inpatient care in a hospital, hospice, or residential health care facility.
  • Any of the above that requires continuing treatment or supervision by a healthcare provider.
  • A serious chronic health condition that requires frequent doctor visits over time (including asthma, diabetes, or epilepsy).
  • Long-term illnesses, injuries, etc., for which treatment may not be effective and supervision is necessary (as with Alzheimer’s, severe strokes, and late-stage cancers).
  • Conditions (like cancer, severe arthritis, or kidney disease) that could incapacitate a patient within 3 days of interrupting treatment (like chemotherapy, physical therapy, or dialysis).
  • Restorative dental or plastic surgery after an injury or removal of cancerous growths.

Qualified caregiving events include:

  • Picking up medication
  • Physical care
  • Emotional support
  • Visitation
  • Assistance in treatment
  • Transportation
  • Assistance with daily living matters
  • Personal attendant services

 

What does NOT qualify as a serious health condition under PFL

While Paid Family Leave aims to cover a wide variety of medical-related needs for time off, there are some things that you will not be able to take paid time off for under PFL, including:

  • Routine examinations which are not considered treatment.
  • A regimen or treatment that can be, and is, initiated without a visit to a healthcare provider, including taking over-the-counter medication (aspirin, antihistamines, salves, etc.), bed-rest, drinking fluids, exercise, and so on.
  • The common cold, flu, ear aches, upset stomach, minor ulcers, headaches (other than medically diagnosed migraines), routine dental or orthodontic problems, periodontal disease, etc. unless complications arise.
  • Cosmetic treatments, such as most treatments for acne or plastic surgery.

 

Paid Family Leave can be taken in increments as small as 1 day. So if your mom has chemotherapy every Monday, or your dad has to go to dialysis every Thursday and you need to be there with them, you can take that day routinely under PFL without having to use up your sick time or vacation days (unless your FMLA policy requires it). If you choose to use those PTO days and receive your full paycheck instead, that is entirely up to you.

If you and a family member both work for the same company and need to take time off to care for your seriously ill family member, you are both entitled to use your full PFL time to do so. It will be up to the employer, however, if you can be out at the same time, or if you need to stagger your time out.

 

What Constitutes a “Family Member”

PFL defines family members as a:

  • Spouse
  • Domestic Partner
  • Child
  • Parent
  • Grandparent
  • Grandchild

It’s worth noting that “parent” is defined very broadly and does not need to be a biological parent.  For PFL purposes, a parent is also:

  • Adoptive parent
  • Foster parent
  • Legal guardian
  • Anyone in loco parentis (who acted as a parent-figure during your childhood)
  • Step-parent
  • And even in-laws

While your domestic partner’s child qualifies as a family member under PFL, if your child is over the age of 18, you won’t be able to take time off to care for them under Paid Family Leave.

How to Take Paid Family Leave

Here are some important steps follow in order to take your paid time off under PFL.

Step 1 - Notify your Employer
Paid Family Leave requires you to give your employer at least a 30-day notice before you plan on taking leave — if the qualifying event is foreseeable, like for planned medical treatment for a serious medical condition. So if your family member is having physical therapy for an extended period of time, you can plan ahead for most, if not all, of that time.

For instances when leave isn’t predictable — like for serious injuries or sudden illnesses — give your employer notice as soon as you’re aware you will need to take Paid Family Leave benefits. This means that either the day of the medical event, or the day after, would be appropriate for employer notification. If you can, tell your employer the amount of time you will need to take PFL. If there is any change to your leave time, notify your employer immediately.

Notifying your employer does not mean you are submitting a claim yet to receive any benefits.

Step 2 - Submit your Claim
The responsibility for applying for Paid Family Leave benefits rests with you, the individual employee. As an employee, you will be in charge of collecting all the necessary documentation and paperwork, getting required signatures, and submitting your claim in order to take PFL and receive benefit payments from your insurance carrier.

We anticipate a main claim form, accompanied by a care givingx-leave-specific supplemental form. Both will be released by New York State later this year.

You will also need to submit the following supporting documentation:

  • Relevant supporting documentation, including certification from your family member’s health care provider.
  • Doctor’s notes.
  • Other related medical forms.

Consider making copies of everything for your own records.

Once your claim and related documents are filed, you can generally expect to be paid within 18 days of filing your complete claim. If any information is missing or incomplete, your claim may be delayed until all required information is accounted for.

There is no waiting period for Paid Family Leave — as is often the case with disability benefits like DBL — which means the first day of your leave qualifies for benefits.

PFL Cares for You While You Care for Your Family Member

You have enough to worry about when a close family member has a serious medical condition — your job shouldn’t be one of those things.  Paid Family Leave provides part of your weekly wage while caring for your loved one, secure in the knowledge that your employment position (or something similar) is waiting for you and that your health insurance will be maintained.

From helping your loved through a treatment regimen to giving them around-the-clock care, you’ll have the time you need to do what needs to be done.

At ShelterPoint, we understand how difficult this time can be, and we do everything we can to ensure that everything moves as smoothly as possible. If you have any questions about taking Paid Family Leave for caring for a loved one, please contact us at pflquestions@shelterpoint.com. You can also check out our ABCs of PFL blog to see all the aspects of PFL and the different benefits it offers you and your family.


This blog post is for informational purposes only and is not intended to provide legal counsel. Please consult with an appropriate professional for legal and compliance advice. Any PFL information is as of the blog post’s date stamp; it is based on the applicable statutes and regulation,  and may change as regulations evolve or NY State issues guidance regarding Paid Family Leave regulations. Got more questions? Email us at pflquestions@shelterpoint.com

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