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Stephanie Haber
/ Categories: Q&A

Paid Family Leave Question & Answer From Our Broker Webinar

May 26, 2017
PFL Questions

We want to thank you for such active participation in our recent Paid Family Leave webinar for brokers. We received more questions than we could answer live on air. As promised, we have compiled answers to the wealth of questions you submitted during the webinar to the best of our knowledge and interpretation of current draft regulations – yes, this includes the just released 2nd round of the Workers Compensation Board’s set of draft regulations! These may, of course, change with release of the final regulations or as we gain additional insights.

For easy navigation, we’ve grouped them by topic areas – and if the same type of question was asked more than once, we’ve kept and grouped the different ways you asked the same thing so that you can easily recognize your own question.


Topic Area: Benefits in General


Is this insurance mandatory just like DBL?
Yes, if you are required to have DBL, you must have PFL.

Does PFL apply to all group sizes? 

How will the PFL qualification period apply to employees currently employed?
Are current employees exempt from the prior qualification period or will prior consecutive employment count?
If they have been with their employer for the minimum qualification period come 1/1/18, they are eligible to file Paid Family Leave claims day 1.

  • Full-time employees must work at least 26 consecutive weeks at their current employer to qualify for Paid Family Leave.

  • Part-timers must complete at least 175 work days at their current employer; and their benefits are pro-rated proportionately based on the average number of days worked over the proceeding 8 weeks worked.

  • This means, if an employee changes jobs from one covered employer to another, their time worked at the previous employer does not count – the Paid Family Leave qualification period starts over.

If PFL is taken in increments of 1 or 2 days at a time, how is the maximum number of days calculated? Would it be the number of weeks allowed multiplied by 5 days in a week?
Yes, this is the correct calculation for full-time employees.

If you take PFL intermittently, do you have to take the equivalent of 60 days over 26 weeks only?
No, the number of days of paid leave you are able to take depends on whether you work full-time or part-time, and is for a period of 52-consecutive weeks.  Also, please note that in 2018 the benefit would be 40 days, since the benefit will be phased in.  

For employees working more than 5 days per week, the maximum number of intermittent leave allowed is 60. 

If an employee uses 12 weeks PFL, when can they take another PFL Leave?
Leave durations are based on the date the leave begins.  Also, please note that in 2018 employees would only be able to use 8 weeks of Paid Family Leave since the benefit will be phased in.

Will your benefit amount increase if the PFL time off begins before 1/1?
No, the benefit amount that is in effect at the time the leave began applies to the full duration of the paid leave for that event, even if a new calendar year with increased benefit levels falls within that period.

Does this cover leave for illness?
No, not for the employee’s own illness – that would be covered under statutory short-term disability (DBL). Paid Family Leave is meant for caring for someone else, such as caring for a seriously ill family member or bonding with a newborn or adopted child.

If an employee is out on leave caring for a sick family member, and that family member becomes hospitalized, does the employee have to return to work?
As long as the employee is still providing care as defined in draft regulations, they may remain out from work. Providing care may include, for example, necessary physical care, emotional support, visitation, assistance in treatment, transportation, arranging for a change in care, assistance with essential daily living matters, and personal attendant services.

To qualify does the family member have to be out of work AND unable to perform ADLs or simply just out of work?
There is no work requirement for the care recipient. A care recipient could be a close family member who is not currently in the workforce (like a child or elderly parent).

Is the PFL benefit considered payroll? Would deductions be made for 401K etc.? 


Topic Area: Benefit Recurrence


Is the amount of PFL time per illness or yearly?
The max duration, is that per year?

Say you have a baby in April 2018 and then your dad gets sick in sometime Jan/Feb the following year, how much time can you take off? Is it 8 weeks per qualifying event or is it 8 weeks total, i.e. if you have more than 1 qualifying event, you have to split the 8 weeks between them. And does the benefit period in this example go from April to April or does the clock reset with the new calendar year?
Per current draft regulations, an employee can’t take more than a total of 8 weeks of Paid Family Leave leave in 2018. So, your sample employee could take 4 weeks of bonding and 4 weeks to care for the family member. It may be per 52-week period – we are, however, still awaiting details on whether this is per calendar year or 52-week period.

If an employee uses this benefit one year, and needs it again during future years, is that allowed, or is it a one-time benefit only?
Yes, this is allowed.

PFL is limited to 8 weeks per year, but is there a lifetime max for PFL?
No, there is no lifetime max.


Topic Area: Bonding Benefits


For birth, if the mother uses PFL, does the father get a separate bank of PFL time off or is it combined with the mother?
Yes, dad gets his own 8 weeks of PFL (increasing over time to 10-12 weeks).

For bonding, can spouses working for same employer take 8 weeks each one after another – or is it a combined 8 weeks per child?
Details around family members working for the same employer and taking leave for the same qualifying event are still to be determined.

Do babies born in 2017 qualify?

How does “layering” of benefits work with PFL - specifically maternity leaves?

  1. Can someone going on maternity leave take both DBL and PFL at the same time? 
  2. Can someone take PFL instead of DBL for a maternity leave?
  3. If, yes, and the company offers a private STD plan in addition to DBL, can they collect STD and PFL at the same time?
  • Re 1: No, mom won’t be able to take DBL and PFL concurrently. But she can start with DBL and then transition to Paid Family Leave to maximize the total time off. The combined duration, however, may not exceed 26 weeks in a consecutive 52-week period for the same qualifying event.
  • Re 2: Yes, someone can choose to take PFL instead of DBL for a birth event.
  • Re 3: It could be possible – please refer to your STD contract for details.  Employers may wish to ensure their STD coverage offsets for Paid Family Leave benefits so that employees are not double-covered.

Can a woman take 8 weeks DBL for the birth of a child, then take 8 weeks of PFL?
Yes, as long as she met all other requirements and did not exceed 26 weeks of benefits in a consecutive 52-week period.

What if a newly hired woman gives birth at 24 weeks (of employment) and therefore becomes eligible 2 weeks into the leave (at 26 weeks), would this be a covered leave after the 26 weeks or is it denied because they were not covered at the date of birth?
We are awaiting guidance from the Workers' Compensation Board on this scenario.

If an employee has a baby in July 2017 and takes FMLA in 2017 right after having the baby, it's unpaid. If he/she prolongs it to 2018, then it will be paid?
Yes, the time taken off under Paid Family Leave will be paid based on the benefit the employee qualifies for.  She could take 12 weeks FMLA now in 2017, and then 8 weeks PFL in 2018.

How about look back periods - we know that anyone who has a baby prior to Jan 1, 2018, can take bonding leave during the first year of the child’s life.  So, someone who has a baby in August of 2017 could take leave after Jan 1.  However, if the company has an internal paid family leave benefit in place currently, ostensibly the employee could take their company’s paid leave after the baby is born in August and then take PFL again in January.  Is there a look back period so that the company isn’t “on the hook” for two paid leaves?
No, there is no look back period.


Topic Area: Claims Process


Does a claim have to get filled out for each day off?

Do we have a sample of claim forms yet?
The Workers’ Comp Board (WCB) has released draft claim forms, but they have not yet filed final versions. What we do know so far is that there will be a general claim form that will be supplemented by leave-type-specific forms.

What needs to be submitted with claim forms for documentation?
New York State’s claim for will provide guidance on acceptable documentation (once it is released).  For example, for a bonding claim a birth certificate may be required, or for military leave a copy of orders may be required.

How soon does an employee have to inform that they will be taking PFL?
An employee must provide the employer with at least 30 days advance notice before the planned paid leave if the qualifying event is foreseeable, such as

  • an expected birth, placement for adoption or foster care;
  • planned medical treatment for a serious health condition of a family member;
  • the planned medical treatment for a serious injury or illness of a covered service member or other

known military exigency

If a 30-day advance notice is not practicable (due to, for example, lack of knowledge, a change in circumstances, or a medical emergency), notice must be given as soon as practicable under the facts and circumstances of the qualifying event, ideally within the time required by the employer’s usual and customary notice internal policy.


Topic Area: Family Member Definition


I would assume that in-laws (father & mother) count as family members?
What about father/mother-in-law?
Is a parent-in-law considered a parent?
Does it include a step parent?
Yes, it includes step parents and in-laws, as a well as biological, foster, or adoptive parent, a legal guardian, or other person who stood in loco parentis to the employee when the employee was a child.


Topic Area: Job Protection


Is your job guaranteed if you take PFL?

What happens to small employers: can they terminate an employee on PFL, or hire a replacement employee?
The employee’s job is protected under PFL just like it is under FMLA. If an employer declines to reinstate an employee returning from Paid Family Leave, the employee has the right to report this to the State. The employer then has 30 days to either take corrective action or file a formal response to the employee, explaining the reason that corrective action will or will not need to be taken.

However, hiring temp staff for the time an employee is on leave or splitting responsibilities among other employees may be a good solution. Now is the time to consider that and start thinking about a staffing plan to cover their workload(s). The sooner employers start exploring all their options and planning for them, the more flexibility they’ll have to provide business continuity when employees begin to take paid leave.


Topic Area: Employer Impact


Can the employer withhold for PFL if they don't withhold for DBL?

Since this will cover a higher limit than DBL, will the carrier automatically reduce the "increase" that the employer had elected, if they had elected a higher DBL payout limit?
No, they are different coverages with benefits for different purposes.

The employer only remits the amount of the current employee level, what happens when there is turnover in the middle of the year, increase or decrease?
Employee counts will be reconciled at time of bill pay.

Can an employer seek reimbursement for PFL if they are providing salary continuation?

Do groups have to implement this by 7/1 or do they have a grace period to implement?
Group have to implement Paid Family Leave effective 1/1/18, which is when the benefit starts. This includes, for example, being ready to administer and track paid leave taken by their employees, collect payroll deductions (if they choose to), and amending their employee handbooks with Paid Family Leave information. There is no grace period with regard to the 1/1/18 date. The 7/1 date has drawn much attention because this is when employers may choose to start withholding from employees for PFL purposes.

If an employee does not have immediate family members that PFL will apply to, should the employee be required to pay premiums? 
What if the employee does not want any money out of their paycheck? Can the employer force them?
Paid Family Leave is a mandatory benefit for employees at covered employers, just like DBL. The only employees who can file a waiver for contributions are those that work less than 26 weeks in a 52-week period (if full-time, or those who collect or are eligible to collect old age social security benefits) or 175 days in a 52-week period (if part-time). Essentially, if the employee is considered an employee under the law and doesn’t meet that description, they are required to contribute. 


Topic Area: Out-of-State Coverage 


Do employers who have employees outside of NY offer them PFL if they offer out-of-state DBL to them?Out-of-state employees?
Can they extend the coverage to those in CT if they want just like NYSDBL?
We are waiting for guidance from NYS regarding out-of-state employees.

What happens if you have employees in CT but the employer is located in NY?
What about an employer who is located in CT but is a NY corporation? 
Coverage requirements are based upon where the employee physically works.


Topic Area: Taxability 


This was a hot topic – many of you asked about taxability:

  • How is the PFL employee holding treated as regards income taxes?
  • If the employer pays the premium, is there additional tax implication to the employee, including taxing the benefit?
  • Will premiums/deductions be pre or post-tax?
  • Is PFL a pre-tax or post tax deduction?
  • Are the employee premiums paid pre-tax or post tax?
  • Is this a pre or post tax deduction? Is the benefit taxable?
  • If premiums are paid post tax, is the benefit taxable?
  • Is the PFL benefit tax-free if it gets 100% employee-funded?
  • Is the benefit taxable if paid 100% by employers? I.e. is it tax free if entirely paid by the employee?
  • Will the benefits be taxable? Will the deductions be taken on a pre or post tax basis?

We are awaiting guidance from the State on benefit taxability. Regardless of who pays the premium, we expect the benefit to be federally taxable.


Topic Area: Exempt Employers/Excluded Classes and Voluntary Coverage 


Does this apply to domestic employee situation?

Does the domestic worker exclusion carry over for employees working less than 40 hours per week?
Yes. If you are considered a covered employer of a domestic employee (working 40+ hours or more per week, and 30 days or more per year), then you must have DBL and PFL. If your domestic employee is working less than 40 hours per week then DBL/PFL is not required.

Is a sole proprietor/owner who has DBL required to add PFL?
What about sole props if they are receiving W-2's for themselves?
Sole Proprietors with employees must have PFL – and we would likely extend the Paid Family Leave rider to the covered proprietor if they were endorsed onto the policy.

Sole Proprietors without employees may opt for voluntary coverage. If they put their voluntary Paid Family Leave policy in place after 01/01/18 or later than 30-days of forming the business, they can still obtain voluntary PFL coverage – however, they may be subject to either:

  • a surcharge (higher premium) or
  • the standard community rate at the expense of a 2-year waiting period on Paid Family Leave benefits


How about School Teachers not required to have DBL, are they required to have PFL?
Do you have to offer PFL to teachers, since they can opt in for DBL?

Is PFL mandatory for municipal entities?

PLF doesn’t apply to public/government employees?
Those groups can choose to offer a Paid Family Leave policy to their employees, but it is not required. 

Are State employees exempt from this benefit that is mandated for all NYS employers?
Yes, State employees are public employees and are exempt from this benefit.

Do unions have to offer PFL?
If they are considered a covered employer and have a DBL policy in place, they will need PFL.

In the case of unionized workplaces, where Collective Bargaining Agreements (CBAs) provide a family leave benefit equal to or exceeding the state-mandated benefit, employers do not have to provide the benefit under the law.  If they already have an acceptable DBL-like coverage in place, but no Paid Family Leave comparable benefit, they can choose to provide Paid Family Leave through a PFL-stand-alone policy.

For exempt employers, can PFL be offered on a voluntary basis?
Can it be a true voluntary plan for public sector group?
Coverage can be provided on a voluntary basis to an entire group if the employer chooses to provide it.  However, individual employees within that group do not have the choice to “opt out” of coverage like they would with a “true voluntary” benefits plan.


Topic Area: PFL & DBL


Can you clarify this one - DBL vs. PFL?
Can you review the benefit level for PFL versus DBL? 

If you're looking for more details beyond what we covered in the DBL-PFL comparison during the webinar, we will be releasing a more in-depth blog feature on this topic in the near future. Stay tuned, and make sure you're Signed up for our updates so you see when it's released!


Topic Area: PFL & FMLA 


Is this FMLA?

Will PFL run concurrently with federal FMLA?
Yes, if concurrent eligibility exists.

Be on the lookout for a blog post with an in-depth comparison of Paid Family Leave vs FMLA coming soon. Make sure you're signed up for our updates so you don't miss it!


Topic Area: Paid Family Leave & Health Insurance 


Looks like this was a hot topic – many of you asked, in essence, the same question:

  • With a requirement of health insurance being maintained during a leave, does it require that the employer pay for that or that that is paid for under the same benefit provisions the employer gives the employee if they were working?
  • With health insurance being maintained, how does that pertain to a contributory group between the employer and employee?
  • Does the employer have to continue to subsidize coverage for medical or can they charge the employee the full rate?
  • When maintaining medical coverage...does the employer assume the full premium? Or is the employee still responsible for the premium while out on PFL?
  • Can employees be billed the entire premium for the health insurance?
  • Is the Employer responsible for the employee portion of health premium?

While out on Paid Family Leave, the employee continues to pay their portion of the health insurance premium at the same level they did prior to their paid leave. If that amount changes during their paid leave, the employee on leave is required to pay the new amount just like all other employees affected by the change.

If an employee contributes to health insurance, how does the employer collect this while they are out? Send them a bill?
It is up to the employer to determine the best method of collection, whether to bill during the leave, or to pay the premium in full and collect upon return.


Topic Area: Paid Family Leave & Other Benefits 


What about the current health and other benefits in place currently.  They don't address PFL.  How can we find out if they do this?
Please refer to the respective contracts for more information.

Can PFL be taken in addition to STD and FMLA?
If by STD you mean the state-mandated short-term disability insurance, no, DBL and Paid Family Leave cannot be taken concurrently. Typically, STD contracts have offset provisions for DBL that pay the STD benefit minus the DBL benefit in per to prevent over-insurance. We anticipate that STD contracts will be updated to similarly offset for PFL – otherwise, more than 100% of pay could be collected.  That said, for a while some carriers’ contracts may not be updated so initially it may be possible to collect both. Please refer to the specific STD contract to be certain.

With regard to FMLA, yes Paid Family Leave and FMLA coordinate.

Do Life, LTD, and Dental have to be continued like Medical does?
This is decided at the employer’s discretion.  We encourage employers to speak with their legal counsel or HR/Tax advisor.


Topic Area: Paid Family Leave & Paid Time Off 


Can the employer coordinate other time off (sick, vacation, etc.) to pay the employee their full pay during a claim?
The employee cannot be forced to take accrued sick/vacation time. They can be offered the opportunity to take earned time off to receive full salary.

Can this be coordinated with PTO the way DBL can?Can we apply paid leave from work (personal days) and also collect on PFL benefits?
No, an employee cannot collect the monetary benefits Paid Family Leave offers while also collecting full salary as a result of paid time off.

When an employee is out for 8 weeks, do they still earn PTO while out? 
Usually, accruals are suspended while an employee is on leave, however this decision is up to the employer; we recommend speaking with a tax professional or legal counsel for guidance.

Topic Area: Pre-funding of Paid Family Leave Premiums 


How do you see surplus of prefunding deductions needing to be refunded?
We recommend you speak to your tax adviser.

If you pre fund deductions and the employee leaves before 1/1/18, is that employee entitled to a refund?No.

If I pay premium annually in advance in July, how do I pay premium for PFL starting in January?
You can start withholding from employees starting July, but you don’t have to remit yet.

If you start collecting payroll deductions early, you will be able to partially pre-fund your annual Paid Family Leave premium based on the number of months during which you collect Paid Family Leave premium in advance.


Topic Area: Rates 


Is the $125 minimum premium for DBL separate from PFL premium?

When will rates be approved for PFL?
What is the range of expected premiums?
Any idea on pricing?
What is the rate estimated at?
Paid Family Leave rates were published by New York State on June 1, 2017.  You can read all the details here. 

Other states (CA, NJ) have PFL benefits. What are those rates?
They are typically payroll based and typically up unto a cap. 

Will the rate be different for males vs females?

How will the self-funders set their rates?
They may not collect more than the maximum employee contribution level set by New York State.

Will the State Fund be offering and charging the same as private carriers like ShelterPoint?
The legislation as written grants the State Fund more latitude in rate setting than it gives insurance companies.  While insurance companies have to charge the rate as set by DFS, the State Fund can make actuarially appropriate adjustments.  We do not know at this time if/how the State Fund may vary rates.


Topic Area: Commissions


How much is the commission? :)
What commission will be paid on this portion by ShelterPoint?
Can you speak to how PFL impacts 1. Commission, 2. base & commish, 3. commission with a draw to pay back?
We hear you and understand that this is top of mind for everyone. However, we can’t determine commissions until after the rates are released. Those are due for publication by the State by June 1. 

 Sign up to stay tuned to our updates to be the first to hear when rates, and our commissions are set!


Topic Area: Sales 


I was not aware that the DBL and the PFL HAS to be the same carrier.  How can we quote both and what do we need?
Our quote system will be updated with Paid Family Leave information late summer. What’s needed to quote will depend on the final rating mechanism.

Can a life and health broker sell these programs?
If you are Accident and Life only can you participate in the PFL like with DBL for commissions?
Is this saleable with ONLY P&C license or can those with A&H continue to sell and service?
Paid Family Leave can be sold with any NYS insurance license.

Will PFL be available on the marketplace?            
No, we don’t expect it to, since this is not a health insurance product.

If a DBL policy is self-funded, and the employer would like to purchase a fully insured PFL plan, could an employer request the plan from ShelterPoint?

If I have some groups without ShelterPoint DBL, can I switch the groups’ DBL to ShelterPoint any time during the year to also implement PFL?


Topic Area: ShelterPoint Practices for Paid Family Leave  


Are premiums going to be paid with DBL at the same time; quarterly, annually, monthly?

Will the PFL be a separate policy or included in with the DBL policy?
For employers with DBL, it will be added in form of a rider. For exempt employers with voluntary stand-alone coverage, it would be a separate policy.

When will the PFL rider be issued to the clients?
We are planning to start mailing out riders to our existing DBL policyholders late summer.

Upon DBL renewals, do you expect to send PFL premiums & claims experience?
Our process for 50+ groups remains the same.

Is the DBL policy picking up the tab for the benefit, same as DBL works now?
PFL will be added as a rider to existing DBL policies. It will have a separate rate from the DBL policy and separate calculations for premium, but be billed together with the DBL.

What materials can we currently send out to our clients right now?
You can:

Plus, be on the look-out for an in-depth NY Paid Family Leave. guide and other materials once all the final regulations are released by New York State.

Will you be directly informing DBL policyholders of your Employer webinar?
Policyholders who are subscribed to our Paid Family Leave. updates, will receive an invitation via email. We encourage you to let your clients know about the updates or send them to the webinar registration page directly.

This webinar is not specifically for current ShelterPoint policyholders but for any employers who want to learn about Paid Family Leave.


Topic Area: Various


How are NY FPL benefits different from NJ and CT?
CT doesn’t have a paid family leave benefit in effect (yet). Please check out our in-depth comparison of NY and NJ here.

Is NYS subsidizing PFL in anyway?

Are lawmakers talking about updating the DBL payments to match PFL?
Currently not.

Would the disability rates for females decrease with this PFL?
Over time, rate adjustments to both the male and female DBL rates are possible as experience builds on Paid Family Leave and more risk details are made available on the PFL and DBL programs.

Is ShelterPoint publicly traded?

How will employers find out that PFL is required? Will there be a notice from the State or the DBL carrier?Please contact the State to find out if there will be a formal state-wide notification. Notice procedures of carriers may vary from carrier to carrier. ShelterPoint will start a formal notification process later this summer.


Thank you once again for all your questions!  We hope we were able to answer them to your satisfaction.  If not, or you have any follow-up questions, please feel free to email us anytime at: pflquestions@shelterpoint.com.

This Q&A 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 as of May 24, 2017, is based on the applicable statutes and may change when Paid Family Leave regulations are issued by the State of New York. Got more questions? Email us at pflquestions@shelterpoint.com

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