While most of us realize that change is a part of life, few ofus can afford to sacrifice our paycheck when it happens.

To help ensure that New Yorkers do not find themselves in thissituation, the state signed into law the nation's strongest andmost comprehensive Paid Family Leave (PFL) policy. Effective Jan. 1,2018, the law provides residents with job-protected, paid leaveto bond with a newborn, care for a loved one with a seriousillness, or tend to family matters when a loved one is called toactive military service.

The new law encompasses numerous leave types, eligibilities anddurations, so processing a PFL claim can be confusing. Tounmuddy the waters, let's dive into the who, when, how and whatregarding PFL.

Who is eligible?

Added to a company's Disability Benefits Law (DBL) policy as arider, Paid Family Leave was created for private-sectororganizations with at least one employee who works in New YorkState at least 30 days of the year. Public companies may opt toprovide coverage as well, but it is not required.

To be eligible for PFL, applicants must be employed by acovered employer at the time they apply.

• Employees with a regular work schedule of 20 or more hours perweek are eligible after 26 consecutive weeks of employment. Thisincludes sick or vacation time, but may not count other coveredleaves.
• Employees with a regular work schedule of fewer than 20 hoursper week are eligible after 175 days worked, which do not need tobe consecutive.

How it works

In 2018, both full- and part-time employees are eligibleto take up to eight weeks of PFL and receive 50% of their averageweekly wage (AWW). The weekly earnings under PFL are currentlycapped at $652.96, which is 50% of the New York State AverageWeekly Wage (NYSAWW) of $1,305.92. (For details, visit www.ny.gov.)

New Yorkers stand to benefit even more in the years to come, asthe state plans to increase PFL incrementally, reaching 12 weeks by2021.

PFL benefits are funded through a small weekly payrolldeduction. The deduction is a percentage of an employee's weeklywage — up to the aforementioned cap.

To provide some perspective, the current payroll contribution is 0.126% of aNew Yorker's gross weekly earnings, capped at a total annualcontribution of $85.56. For example, an employee earning $1,200 aweek in 2018 would pay $1.51 per week. To calculate an employee'sweekly deduction, simply enter the required information at www.ny.gov/paid-family-leave-calculator.

A healthy dose of security

Not only will eligible applicants receive a portion of theirwages while on leave, qualifying employees can rely on continuedhealth insurance coverage while taking PFL. Employers are requiredby law to continue the existing health insurance benefits. Ifemployees contribute to the cost of their health insurance, theyare also required to continue paying their portion while onleave.

It is important to note that Paid Family Leave does notreplace disability benefits coverage. Disability benefits are meantto cover off-the-job personal illness or injury. PFL isdesigned to provide paid time off to care for family that needassistance.

In fact, some employees may be eligible for both PFL bonding anddisability benefits for maternity at the same time, although theymay not be taken simultaneously, according to the New York StateWorkers Compensation Board.

Leave categories

PFL is flexible and may occur in a variety of ways. Theapplicant has options when deciding how much time to take at anygiven time. While the law states that a 30 day leave notice isrequired, there are considerations for times when life surprisesus.

There are four main PFL categories:

• Continuous leave: The employee takes theentire 8 weeks of PFL without interruption.
• Intermittent leave: The employee takes leavein increments as short as one day at a time.
• Foreseeable event: The leave begins followinga planned event such as a birth, adoption, surgery or militaryceremony.
• Non-foreseeable event: The leave is inresponse to an accident or an unexpected surgery.

PFL-worthy events

As mentioned earlier, an employee can request PFL for one ofthree reasons. The State of New York classifies these leaves asBonding, Family Care and Military Exigency. Each type has its own eligibility terms andrequired documentation. If your company or agency does not havethe required forms on hand, they are available at www.ny.gov. Employeesrequesting PFL are required to do so at least 30 days in advance,when possible, starting with Form PFL-1.

Bonding Leave — A parent may takePFL during the first 12 months following the birth, adoption orfoster placement of a child. To start the application process, anemployee will need to obtain the “Bond with a Newborn, NewlyAdopted or Fostered Child” forms package.

From there, the employee would complete a “Request for FamilyLeave” (Form PFL-1) and submit it to his or her employer, who willcomplete the employer section and then return it to the employee. APFL-1 is required for all three types of leave. Also required isthe “Bonding Certification” (Form PFL-2). The employee mustcomplete and submit both forms, along with any supporting documentation (e.g., birthcertificate, adoption certificate, etc.), to the employer'sinsurance carrier.

Family Care Leave — New Yorkershave the right to take time off to care for a loved one with aserious health condition. This individual could be a spouse ordomestic partner, child or stepchild, as well as a parent,stepparent, parent-in-law, grandparent or grandchild.

After obtaining a “Care for a Family Member with Serious HealthCondition” forms package, the employee must submit a completedPFL-1 to their employer, who will complete it and return it to theemployee. Additionally, the employee's family member (the carerecipient), or their authorized representative, is required tocomplete a “Release of Personal Health Information Under the PaidFamily Leave Law” (Form PFL-3). Upon completing the release, theindividual will submit it to his or her health care provider.

The second form the employee is required to complete is the“Health Care Provider Certification” (Form PFL-4). Upon completion,this form will go to the employee's health care provider forreview, then to the care recipient and ultimately back to theemployee. The employee must submit the PFL-4, along with his or hercompleted PFL-1, and PFL-3, to his or her employer's insurancecarrier.

Military ExigencyLeave — If an employee's spouse,domestic partner, child or parent is deployed abroad or has beennotified of an impending deployment, the employee can take PFL toassist or support the military member and his or her family.Examples include making financial and/or legal arrangements on themilitary member's behalf, attending military-related ceremonies forthe deployed individual and tending to urgent childcare needscreated by the family member's deployment.

To begin the process, the employee must obtain the “AssistFamilies in Connection with a Military Deployment” forms package.Next, the employee will need to complete a PFL-1 and submit theform to his or her employer. The employee must then complete the“Military Qualifying Event” (Form PFL-5), attaching any supportingdocumentation (e.g., covered active duty orders, letter from themilitary unit confirming deployment, etc.). The employee will thensubmit his or her employer-approved PFL-1 and completed PFL-5 tothe employer's insurance carrier.

Employer obligations

For employers, when it comes to PFL claims, compliance is key. Here are a few importantobligations:

• New York employers are required to complete and return asubmitted PFL-1 within three business days of receiving it.
• If an employer provides health care, the employer must maintaincoverage while the employee is out on leave.
• As mentioned earlier, employers must provide the same or asimilar job upon the employee's return from leave.

While honoring these obligations are the law, doing so can bechallenging for business owners, especially in the case of anintermittent leave. This new coverage will ramp up over the nextfour years, rates and benefit details are subject to changes by theNew York Department of Financial Services(NYDFS).

It is critical to stay in-the-know about this new and developingcoverage. Employers can look to their local insurance professionalsfor help navigating the ins and outs of this groundbreaking law,starting with filling out an employee census to determine theirrelated premiums.

Joy Maas is Director of Business Development, MarketingStrategy and Account Management for AmTrustFinancial Services. She can be reached at 715-398-0166or at [email protected].

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