Paid Family Leave Insurance - Frequently Asked Questions

Frequently Asked Questions
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PAID FAMILY LEAVE INSURANCE: EMPLOYEES

Eligibility
Cost
Relation of the Paid Family Leave Insurance Program to the Family Medical Leave Act (FMLA) and the California Family Rights Act (CFRA)
Benefits
Voluntary Plans
Claim Forms

ELIGIBILITY

Who does Paid Family Leave cover?

Employees covered by State Disability Insurance (SDI) are also covered by Paid Family Leave insurance. If a Voluntary Plan Insurer provides your company's disability insurance coverage, then it must also provide Paid Family Leave insurance coverage.

Are self-employed individuals covered by Paid Family Leave?

Yes, but only if they participate in the SDI Elective Coverage Program.

I work for a government entity. Am I covered?

Some government workers, including school employees, may be eligible for Paid Family Leave insurance benefits if they contribute into the SDI program. Also, if you have wages from a private employer during the base period, you might qualify even though your primary employer is a government entity.

I work for a small business. Am I covered?

Employees are covered for Paid Family Leave insurance benefits regardless of the size of their employer, provided they contribute to the SDI program.

I work for a small business with 15 employees. I've notified my employer that I need to take time off work to provide care for a seriously ill parent and will be claiming Paid Family Leave insurance benefits. Is my employer obligated to grant me time off and to retain me as an employee with the company?

Your employer is not obligated to grant time off nor is your employer obligated to hold your job for you unless your employer is covered by the Family and Medical Leave Act and the California Family Rights Act. Unlike these laws, Paid Family Leave insurance is not a form of job protection. In other words, it does not give you the right to take leave.

May I receive Paid Family Leave insurance benefits if I work part time?

If you work part time and still suffer a wage loss due to your family care leave, you may receive benefits provided you are otherwise eligible. Paid Family Leave insurance is a wage loss protection program, which means that individuals may be eligible for a portion of the Paid Family Leave insurance benefit if they are suffering a loss of wages and meet the other Paid Family Leave eligibility requirements.

In what situations may I claim Paid Family Leave insurance benefits?

An employee may submit a claim for Paid Family Leave insurance benefits for the following reasons:
- To care for a seriously ill child, spouse, parent, or registered domestic partner;
- To bond with the employee's new child or the new child of the employee's spouse or registered domestic partner; or
- To bond with a child in connection with the adoption or foster care placement of the child with the employee or the employee's spouse or registered domestic partner.

What constitutes a serious health condition for the purposes of Paid Family Leave?

A serious health condition means an illness, injury, impairment, or physical or mental condition of a patient that involves inpatient care in a hospital, hospice, or residential medical care facility. This includes any period of incapacity (e.g., inability to work, attend school, or perform other regular daily activities) or any subsequent treatment in connection with such inpatient care; or continuing treatment by a physician or practitioner Unless complications arise, cosmetic treatments, the common cold, influenza, earaches, upset stomach, minor ulcers, and headaches other than migraine, are examples of conditions that do not meet the definition of a serious health condition for purposes of Paid Family Leave.

Do I have to work a minimum number of hours or days before becoming eligible for Paid Family Leave insurance benefits?

No. Eligibility for Paid Family Leave insurance benefits is based on the earnings shown in your base period and not a specific number of days or months worked. Wages earned approximately 5 to 17 months before the beginning of your Paid Family Leave insurance claim are included in the base period.

Is there a waiting period for Paid Family Leave insurance benefits?

Both SDI and Paid Family Leave require a seven (7) calendar day non-payable waiting period.

Does the seven (7) day waiting period for Paid Family Leave need to be seven consecutive days?

No. The required seven-day waiting period does not need to be taken seven days in a row. For example, if care were provided one day per week, the seven-day waiting period would be served over a seven-week period. Benefits are payable once the seven days have been served and all other eligibility criteria are met.

How many days must I be off work to receive Paid Family Leave insurance benefits?

At least eight (8) calendar days.

Do I need to take all of my Paid Family Leave insurance benefits at one time?

No. The law does not establish a minimum number of hours or days or weeks that an employee must take Paid Family Leave insurance benefits. It only established the maximum leave time of six (6) paid weeks within a 12-month period.

If I receive six weeks of Paid Family Leave insurance benefits to bond with my newborn and then one of my parents becomes seriously ill later in the year, will I be able to receive Paid Family Leave benefits again since it is for a different reason?

You are limited to 6 weeks of benefits within a 12-month period regardless of the reason for the leave.

Am I required by law to use my vacation leave when collecting Paid Family Leave insurance benefits?

The law gives an employer the discretion (option) to require an employee to take up to two weeks of earned but unused vacation leave. Vacation leave may include paid time off. This option does not relieve employers of any collective-bargaining duties they may have with respect to vacation leave.

If I have not accumulated two weeks of vacation leave do I have to use my earned but unused sick leave instead?

No. The Paid Family Leave law does not authorize employers to require the use of sick leave in lieu of vacation.

Can I use Paid Family Leave back-to-back with my Disability Insurance claim for pregnancy? Will there be an additional seven-day waiting period for Paid Family Leave?

You may apply for Paid Family Leave insurance benefits as soon as you have recovered from your pregnancy-related disability and you are no longer in receipt of State Disability Insurance (SDI) benefits. There is no additional seven-day waiting period for a Paid Family Leave claim for benefits to bond with a newborn when the Paid Family Leave claim follows the SDI pregnancy-related claim. You will automatically be sent a Claim for Paid Family Leave (PFL) Benefits - New Mother, DE 2501FP, when your pregnancy-related disability claim ends.

When must I submit a claim to bond with a new minor child in order to receive six weeks of benefits?

Eligibility for up to six weeks of benefits to bond with a new minor child expires at the end of the 12-month period that begins on the minor child's date of birth, adoption, or foster care placement. Therefore, you must complete your bonding prior to the 12-month period ending date and submit your claim timely.

Is a claimant eligible for Paid Family Leave insurance benefits if he/she has to provide care for a sick parent that is out-of-state or out-of-the-country?

A claim may be submitted for Paid Family Leave benefits to care for a sick parent who is out of the state or out of the country. Benefits may be payable provided the medical certificate is properly completed, establishes a need for care, and a claimant is otherwise eligible.

Are mothers-in-law and fathers-in-law included as care recipients under Paid Family Leave?

Mothers-in-law and fathers-in-law are not included as care recipients under Paid Family Leave.

Can an employee opt out of the Paid Family Leave insurance program?

Paid Family Leave is a component of State Disability Insurance and contributions are mandatory under the California Unemployment Insurance Code.

May both parents collect benefits at the same time to bond with the same new child?

Yes. An employee may receive up to six weeks of benefits provided all other eligibility criteria are met.

COST

How much does it cost?

The cost of Paid Family Leave insurance is incorporated into the SDI contribution rate. The SDI contribution rate is .8 percent. The taxable wage limit in 2008 is $86,698. This means that wages above this amount are not taxed for SDI.

RELATION OF THE PAID FAMILY LEAVE INSURANCE PROGRAM TO THE FAMILY AND MEDICAL LEAVE ACT (FMLA) AND THE CALIFORNIA FAMILY RIGHTS ACT (CFRA)

What is the difference between Paid Family Leave insurance and employee leave laws?

The FMLA and CFRA are federal and state leave laws, respectively, that allow workers to take up to 12 workweeks of unpaid leave from their jobs in a 12-month period to care for themselves or family members who are ill, or children who are unable to take care of themselves. Paid Family Leave insurance does not change either law in any way and is completely separate from them. It merely provides up to six (6) weeks of paid benefits to workers who suffer a wage loss when they take time off work to care for others.

For more information about FMLA, visit the Department of Labor's Web site at www.dol.gov. For more information about CFRA contact the California Department of Fair Employment and Housing at 1-800-884-1684 or visit them on the Web at www.dfeh.ca.gov.

Are employees required to take leave under the federal FMLA and the CFRA at the same time they are receiving Paid Family Leave insurance benefits?

Yes, if your company is subject to the provisions of FMLA and CFRA. For additional information about the CFRA, visit the State Department of Fair Employment and Housing's Web site at www.dfeh.ca.gov.

Is a Paid Family Leave claimant's job protected?

The Paid Family Leave program does not protect anyone's job. It simply provides partial wage replacement when an employee cannot work due to the need to care for a child, parent, spouse, or registered domestic partner, or to bond with a new minor child. Some employees may have their job protected under other laws, such as the FMLA or the CFRA.

BENEFITS

How soon will I receive my first check from Paid Family Leave after I mail my claim form?

Most claimants are sent Paid Family Leave checks within two weeks after a properly completed claim is received. By filling in your claim completely and verifying that all information is correct, you play a valid role in maintaining fast benefit check delivery.

How will you determine my weekly benefit amount for Paid Family Leave insurance?

We calculate your weekly benefit amount based on the calendar quarter with the highest earnings in your base period. The base period covers 12 months and is divided into four consecutive quarters of three months each. The wages you were paid approximately 5 to 17 months before your claim begins are included in the base period (they must be subject to the SDI tax). Your base period does not include wages paid at the time your claim begins.

NOTE-If you received SDI pregnancy disability benefits and then file a Paid Family Leave insurance claim to bond with your new child, your weekly benefit amount is the same as your SDI weekly benefit amount. There is no new calculation of your weekly benefit amount when your bonding claim follows your SDI pregnancy claim. This is true even if your bonding claim does not immediately follow your SDI pregnancy claim.

January, February, or March, your base period is the 12 months ending last September 30. (Example: A claim beginning February 14, 2008, uses a base period of October 1, 2006, through September 30, 2007.)
April, May, or June, your base period is the 12 months ending last December 31. (Example: A claim beginning June 20, 2008, uses a base period of January 1, 2007, through December 31, 2007.)
July, August, or September, your base period is the 12 months ending last March 31. (Example: A claim beginning September 27, 2008, uses a base period of April 1, 2007, through March 31, 2008.)
October, November, or December, your base period is the 12 months ending last June 30. (Example: A claim beginning November 2, 2008, uses a base period of July 1, 2007, through June 30, 2008.)

How much will I receive?

For Paid Family Leave claims beginning on or after January 1, 2008 weekly benefits range from $50 to a maximum of $917. To qualify for the maximum weekly benefit amount ($917) an individual must earn at least $21,650.92 in a calendar quarter during the base period.

Will my Paid Family Leave insurance benefits equal my full pay?

Your weekly benefit amount will be approximately 55 percent of your earnings up to the maximum weekly benefit amount.

How long can I receive Paid Family Leave insurance benefits?

You may receive up to six (6) weeks of Paid Family Leave insurance benefits during a 12-month period.

May an employee receive other benefits while also collecting Paid Family Leave insurance?

An employee may not receive Paid Family Leave insurance benefits if he or she is receiving or will receive State Disability Insurance, Unemployment Compensation Insurance, or Workers' Compensation benefits for the same period. Other benefits, such as employer paid benefits for baby bonding, may also affect payment of Paid Family Leave benefits.

How is the Paid Family Leave insurance benefit affected when an employee receives sick leave benefits and Paid Family Leave at the same time?

Consistent with the SDI program, sick leave benefits are treated as wages. Paid Family Leave (PFL) insurance benefits will be reduced by the amount of sick leave benefits received, and may render the employee ineligible for PFL benefits depending on the amount of sick leave benefits received and the employee's weekly PFL benefit amount.

If an employer integrates (coordinates) the sick leave (pays sick leave wages in an amount which is the difference between the Paid Family Leave insurance benefit and the full wage), the sick leave benefits received by the employee will not affect the PFL benefit.

How are Paid Family Leave insurance benefit payments treated for tax purposes?

The federal Internal Revenue Service (IRS) has informed the Department that Paid Family Leave (also known as Family Temporary Disability Insurance) payments are in the nature of unemployment compensation under Section 85 of the Internal Revenue Code. The Department must report the Paid Family Leave payments to the IRS on a Form 1099G and, for federal tax purposes, Paid Family Leave payments must be included in a claimant's gross income.

For some, the fact that the Paid Family Leave program is employee-funded may reduce the amount of Paid Family Leave payments that must be included in the gross income of the claimant (IRS regulation 26 Code of Federal Regulations � 1.85-1(b)(1)(iii)). Claimants should contact the IRS or their tax advisor to obtain additional information.

For state tax purposes, Paid Family Leave payments are not taxable. The Department has received a decision from the state Franchise Tax Board (FTB) that Paid Family Leave payments are not taxable by California pursuant to Revenue and Taxation Code section 17083.

VOLUNTARY PLANS

If I am covered by a voluntary plan for disability coverage, am I covered for Paid Family Leave insurance?

As of July 1, 2004, all voluntary plans were required to add a provision to include benefits to care for a seriously ill family member or bond with a new minor child.
If I am covered by a voluntary plan, how do I claim benefits?

You must contact your employer for claim filing information and then your employer or its agent will pay benefits directly to you if you are eligible.
If I file a claim to care for a family member or bond with a new child, how much will I be paid by my voluntary plan?

CLAIM FORMS

How do I submit a claim for Paid Family Leave insurance benefits?

Claims to provide care or to bond must be submitted on the Claim for Paid Family Benefits form, DE 2501F. When benefits are requested due to a need to provide care for a seriously ill family member, a medical certificate that supports the claim of a serious health condition warranting care is required. The DE 2501F contains a medical certificate that must be completed in the instance noted above. Benefits to bond with a new minor child are limited to the first year after birth, adoption, or foster care placement of a child and a medical certificate is not required. However, evidence of your relationship to the new child must be submitted with your claim.

If you are a woman currently receiving SDI pregnancy-related benefits, it is not necessary to request a Claim for Paid Family Leave Benefits. You will automatically be sent a Claim for Paid Family Leave (PFL) Benefits - New Mother, DE 2501FP, when your pregnancy-related disability claim ends.

Are employers required to provide Paid Family Leave insurance claim forms to their employees?

No.

How can I obtain the claim form for Paid Family Leave?

To order a claim form, call 1-877-BE-THERE. For orders over 25, use the Internet Order Form.

Can the claim form for Paid Family Leave be downloaded?

The Claim for Paid Family Benefits form, DE 2501F, has been designed to facilitate the use of advanced "data capture" technology and thus cannot be duplicated or reproduced. Each claimant must complete an original DE 2501F form to submit a claim for benefits.

Are there specific timeframes for submitting a claim to provide care for a child, parent, spouse, or registered domestic partner or bond with a new minor child?

You must complete and mail a claim form no later than 42 days from the first day for which you may be paid due to the need to provide care or bond. If your claim is late you may lose benefits.

My registered domestic partner and I have a new minor child under the age of 1 year who is my partner�s biological child. I would like to receive Paid Family Leave benefits to bond with our new child. What paperwork do I need to submit to apply for PFL benefits?

In order to qualify for bonding benefits, you must complete a Claim for Paid Family Leave (PFL) Benefits, DE 2501F, and attach appropriate documentation that proves your relationship to the new minor child. In your case, you would mark �other� on questions A17 and B3 of the claim form which ask your relationship to the child and indicate in question B10 one of the documents you will be providing that proves your partner is the child�s biological parent. In addition, to prove your relationship to the biological parent you will need to include a copy of your Certificate of Registered Domestic Partnership and mark the �other� box in question B10. Attach copies of both documents to your claim form and mail in the envelope provided with the claim form.

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