Stephanie Haber

PFL Eligibility Through The Looking Glass

Original Post Date: November 29, 2017
Revised Date: January 24, 2018

PFL Eligiblity

Eligibility can mean a couple of different things, and if you’re not familiar with the different meanings, it can get a bit confusing to understand if/when you can actually start taking paid time off under Paid Family Leave. That’s because coverage eligibility and eligibility to request PFL are not the same. What do we mean by that?

You may be eligible for coverage BUT you may not be eligible to actually request Paid Family Leave or receive benefits yet. So in order to be able to go out on PFL, you have to be eligible for coverage and have satisfied all the requirements to use the Paid Family Leave benefit.

First things first: How do you know if you’re eligible for coverage?
Since your employer will be the one to provide PFL coverage, your first hurdle is based on whether you’d get Paid Family Leave through your employment:

  • You work in NY State
    • whether on premises at your employer or from home
    • any amount of hours (regardless of part-time or full-time)
    • for an employer in the private sector with at least 1 employee who works at least 30 days per year in NY State
    • as a personal/domestic employee (like a nanny, housekeeper, home health aide, etc.), who works at least 30 days per calendar year at 40+ hours per week for the same employer


In insurance speak, these employers are referred to as a “Covered Employer” because they have to provide this coverage by law (just make a mental note of that terminology as we’ll be referring back to it later).

While we’re at it, one more thing to keep in the back of your head: Paid Family Leave will be implemented as part of statutory short-term disability insurance (commonly referred to as DBL). This means, “Covered Employer” refers to both types of coverages, DBL and PFL, and there are some dependencies between the two with respect to benefit eligibility. We’ll get to that.

Check? Check.

Ok, the next hurdle is based on your type of job:

  • You don’t fall into an excluded occupation or class of employees.

 

PFL Expert Tip:
So, even if you work for an organization that has to provide Paid Family Leave (as part of your DBL coverage), your particular occupation or employee class may be excluded – such as high school students, farm laborers, executive officers at 501(c)3 religious/charitable/educational institutions, etc. See the full list of exclusions here.

 

This leads us to the general rule of thumb: You can assume that if you have DBL now and your current employment circumstances don’t change, you should be eligible for PFL coverage next year.

What if you don’t fall into any of these covered categories (you’re either an excluded class or don’t work for a “Covered Employer”)?
Employers that would normally be exempt (such as organizations in the public sector) or have excluded classes of employees can choose to provide coverage. Since your employer may have opted in to provide coverage on a voluntary basis, we encourage you to confirm with your employer whether you are thereby considered eligible for coverage. Read more about exempt employers and voluntary coverage here.

Got the green light? You’re eligible for PFL coverage?
While you are eligible for coverage, your employer may already withhold your Paid Family Leave contributions, BUT you may not be eligible to actually use PFL yet. So, let’s look at what it takes to be eligible to actually request paid leave benefits under PFL.

You must make it through what’s called a “qualification period”:

  • If you work 20 or more hours per week, you must have been employed at least 26 consecutive weeks at your current employer
  • If you work less than 20 hours a week, you must have completed at least 175 work days at your current employer

What counts towards the qualification period:

  • Approved vacation
  • Personal time
  • Sick time
  • Other time away from work - you are still considered an employee as long as your Paid Family Leave coverage is paid

But time out on DBL does not count towards your qualification period.


If you change jobs, your time worked at the previous employer does not count. In other words, you start over with a new qualification period.

pfl eligibility

What does that mean now in 2018 — will you be able to go out on Paid Family Leave at the start of the year?
To take leave right at the beginning of 2018, you need to have worked at your current employer for the applicable qualification period. In other words: if you work 20+ hours, you must have been with your employer (who’s providing PFL coverage) since at least July 3, 2017, to satisfy the 26-week qualifying period by 1/1/18.

But say you switched employers, or you started your first full-time job in October 2017. You would not be able to go out on PFL until you satisfy the 26-week qualification period, which would put you somewhere around April for your first day of potential Paid Family Leave.

 

PFL eligibility

Download above images as a PDF here!

If you’re eligible to request PFL does that mean you’re eligible to receive benefits?
Well, that depends on several factors. And with this question, we’re shifting into the subject of claims. Detailed claims guidance will be available soon. But for now, here are a few key considerations:

  • Under Paid Family Leave, you’re eligible for benefit payments back to day 1 of your paid time off – there is no waiting period like with statutory short-term disability (DBL). Under DBL, your first 7 days are unpaid.
  • You can’t be out on DBL and PFL at the same time.
  • You can’t take more than 26 weeks combined for DBL and PFL per consecutive 52-week period. So if you were out on DBL for 22 weeks due to your own health condition, that would leave you with only 4 weeks of Paid Family Leave until you hit the “anniversary date” of that DBL claim.
  • While DBL is for your own non-occupational injury or illness, Paid Family Leave is used to care for/bond with a family member or attend to family matters due to a military exigency. Read more about each leave event here: Bonding  |  Care  | Military
  • How much you could expect as your benefit payment depends on your wages. See this page for details on how much and how long PFL pays.
  • You must follow the proper steps:
  1. Notify your employer before your anticipated leave under Paid Family Leave first:
    at least 30 days advance notice before your planned paid leave if it’s foreseeable, such as an expected birth, a planned medical treatment for a serious health condition of a family member, or a known military exigency.
    If that’s not possible (due to, for example, lack of knowledge, a change in circumstances, a medical emergency, or short-notice deployment), you need to give notice must be given as soon as practicable – either the same day or the next business day.
  2. Submit your claim within 30 days of your first day of PFL.
    Provide all required supporting documentation – check back for detailed claims guides coming soon or read one of these in the meantime: Bonding  |  Care  | Military
  • If your employer has 50 or more employees, you’re automatically protected under FMLA (Family & Medical Leave Act). This comes with additional considerations and coordination, such as:
    • If your leave under Paid Family Leave is also a qualified leave under FMLA and depending your employer’s established leave practices, you may be required to exhaust your accumulated paid time off (vacation/sick/personal) days first before you can go out on Paid Family Leave. Assume you didn’t want to use up your entire cushion of paid time off, you would not make it to the point in time where you could request paid time off under PFL.
  • Paid Family Leave provides more than just a monetary benefit – it provides job security for employees out on paid leave, similar to unpaid leave under FMLA, but regardless of the size of the employer.

 

Does coverage eligibility for PFL line up with eligibility for statutory short-term disability (DBL)?
No. Read our blog post comparing DBL and PFL for details.

 


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. Have more questions? Email us at pflquestions@shelterpoint.com

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