State Disability & Paid Family Leave Reference Guide

W W W . I N S U R A N C E W H O L E S A L E R . C O M
State Disability & Paid Family Leave
Reference Guide
Understanding Rights & Benefits

My father used to say,
"Nickels, Dimes and Quarters make Dollars." This wise phrase reminds me that small savings can
add up to significant amounts over time. " It's not about how much money you make but how much
you can keep.“ To build a successful business, my father advised me to "expand and scale out like Los
Angeles, rather than up like New York. Instead focus on broadening the business horizons while
maintaining the core values of what we do best."
He also reminded me to "stay true to our expertise, as we have been providing required state
disability, paid family leave, and ancillary employee benefits since 1976. " His words of wisdom have
always inspired me to stay grounded and work towards achieving long-term success.
Founder

FMLA & PFL Overview
Paid Family Leave Benefits
Paid Family Leave Policy
Qualifying Reasons
Paid Family Leave Status (All States)
Providing Care
Family Member
Medical Certification
Employee Notice
Military Exigency
Collective Bargaining Units
Employer Obligations
Health Insurance
Reinstatement
Discrimination/Retaliation
Our Partners
Bind DBL/PLF
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INDEX

FMLA & PFL
Overview
The FMLA applies to all private sector employers of 50 or more employees in 75
miles radius.
Family member is defined as child, parent (parent in-law), grandparent, grandchild,
spouse, or domestic partner.
Leave may be taken to provide care (physical or psychological) for a family member.
Leave may be taken to bond with the employee's child within the first twelve
months after the child's birth, or the first twelve months after the placement of the
child for adoption or foster care.
Leave may be taken for a qualified military exigency, as defined by the FMLA.

NY Paid Family Leave
Benefits
Employees must be employed for 26 weeks before they are eligible for paid family
leave (175 days for part-time employees).
Employees returning from leave are entitled to return to their same or comparable
position without loss of benefits they would have accrued otherwise.
PFL will run concurrently with FMLA if for same qualifying leave reason.
Employers must continue the employees' health insurance during leave as if they
were not on leave.

Benefits
Income replacement will be paid for by an insurance policy procured by the
employer on behalf of the employee, the full cost of which will be paid by payroll
contributions of the employee*.
Public entities may opt-in to provide PFL coverage to their employees.
The Superintendent of Financial Services shall set the maximum employee
contribution annually starting June 1, 2017.
* Employer may choose to pay

Benefits
January 1, 2018; up to 8 weeks of leave
at 50% of the employee's average weekly
wage to a maximum of 50% of the state’s
average weekly wage; $653.00
January 1, 2021 and thereafter; up to 12
weeks of leave at 67% of the employee's
average weekly wage to a maximum of
67% of the state’s average weekly wage;
$875.00.
Year
Leave
Length
% of
Employee's
Average
Weekly Wage
Maximum Weekly
Benefit
January 1, 2018 8 weeks 50% $653.00
January 1, 2019 10 weeks 55% $718.00
January 1, 2020 10 weeks 60% $784.00
January 1, 2021
& thereafter
12 weeks 67% $875.00
States Average
Weekly Wages
$1,305.92 *
*SAWW changes yearly
M A X I M U M B E N E F I T C H A N G E S A N N U A L L Y

Policies
PFL benefits: Employees may not receive PFL & DBL benefits at the same time.
PFL policies: The maximum combined DBL & PFL leave is 26 weeks in a 52-week
period.
Payment of benefits: If the employer has an internal policy that provides the
employee with full wages while the employee is on Paid Family Leave, the employer
can pay the employee up front and then request reimbursement from the insurance
carrier, up to the amount of the Paid Family Leave benefit
PFL coverage: Every policy of insurance issued must offer coverage for both
disability and family leave benefits.

Qualifying Reasons
Inpatient Care or Continuing Treatment
Inpatient care in a hospital, hospice or residential health care facility.
Continuing treatment or continuing supervision by a health care provider.
Continuing treatment/supervision:
Three or more continuous days unable to work, attend school, perform regular
daily activities.
Treatment two or more times by a health care provider.
At least one treatment that results in a regimen of continuing treatment under
the supervision of a health care provider.

Qualifying Reasons
Chronic Serious Health Condition Family Member
Any period in which a family member is unable to work, attend school, perform regular
daily activities due to a chronic serious health condition.
Continues over an extended period of time.
Requires periodic treatment by a health care provider.
May cause episodic rather than continuing incapacity (e.g. asthma, diabetes, epilepsy).

Qualifying Reasons
Long-Term or Permanent Incapacity Family Member
Inpatient care in a hospital, hospice or residential health care facility.
Continuing treatment or continuing supervision by a health care provider.
Continuing treatment/supervision:
Three or more continuous days unable to work, attend school, perform regular
daily activities.
Treatment two or more times by a health care provider.
At least one treatment that results in a regimen of continuing treatment under
the supervision of a health care provider.

Qualifying Reasons
Restorative Surgery or a Serious Condition
A period during which a family member is unable to work, attend school, perform
regular daily activities, or is otherwise incapacitated because he or she is receiving
treatment (including any period of recovery therefrom) by a health care provider
for:
Restorative surgery after an accident or other injury
A condition that would result in incapacity of more than 3 consecutive days in the
absence of treatment (e.g. cancer-chemotherapy/radiation, severe arthritis (PT), or
kidney disease (dialysis))
"Treatment"

Family and Medical Leave Act
Map
All States & Regions

Family Paid Leave Programs Status
Overview
New York Paid Family Leave
New York was one of the first states to introduce a
Paid Family Leave (PFL) program underwritten
privately by the same insurance brokers that
provide DBL short-term disability coverage in
New York. In 2017, when PFL was introduced, it
was written as a rider to DBL. Today, brokers can
write a separate policy for PFL, offering lowering
premiums and better service.
In 2021, New York PFL was fully rolled out,
offering 67% of an employee’s average weekly
wage.
In effect with private options available

Overview
New Jersey Paid Family Leave
New Jersey’s Family Leave Insurance is written by
the state as a rider to Temporary Disability
Benefits (TDB) insurance. Insurance brokers can
help their clients privatize TDB coverage for
better service and reduced premium costs.
New Jersey FLI pays out 85% of an employee’s
average weekly wage, up to a maximum of $1,025
per week in 2023.

Overview
Connecticut Family & Medical Leave Act
Connecticut combines short-term disability coverage for
workers with family leave in its PFML program. One of
the most generous programs in the country, with a very
broad definition of who qualifies as a family member
under the plan, Connecticut PFML pays 95% of an
employee’s average weekly wage up to 40 times the state
minimum wage, and then 60% of the average weekly
wage up to 60 times the state minimum wage, with a
maximum weekly benefit is $840 in 2023.
Maximum weekly benefit is $900 Starting June-1-2023.
Connecticut PFML went into full effect in January 2022.

Overview
Massachusetts PFML
Massachusetts fully rolled out its family and medical
leave benefits on January 1, 2021, although paid leave to
care for a family member with a serious health condition
did not go into effect until July 1, 2021.
Paid leave under Massachusetts FMLA varies based on
the reason for the leave, ranging from 12 weeks to care
for a family member or a child, up to 26 weeks to care for
a family member in the military who has a serious health
condition. Medical leave for the employee can last up to
20 weeks. PFL leave at 12 weeks and a combined leave
duration of 26 weeks.
The benefits received vary based on the employee’s pay,
and max out at a weekly benefit of $1,129.82 in 2023.

Overview
New Hampshire NH PFML
New Hampshire Paid Family and Medical Leave (NH
PFML) plan is a first in the nation, state-sponsored,
voluntary insurance plan where NH employers and
eligible NH workers can purchase PFML insurance,
providing 60% wage replacement (up to the Social
Security wage cap) For up to six weeks per year for
absences from work for a worker’s own serious health
condition, including child birth, to bond with a child
during the first year of birth (including placement for
adoption or fostering); for a worker to care for a family
member with a serious health condition;
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Overview
For a qualifying urgent demand or need arising out of
military exigency; or to care for a covered service
member with a serious injury or illness. For up to six
weeks per year for absences from work for a worker’s own
serious health condition, including child birth, to bond
with a child during the first year of birth (including
placement for adoption or fostering); for a worker to care
for a family member with a serious health condition; for
a qualifying urgent demand or need arising out of
military exigency; or to care for a covered service
member with a serious injury or illness.
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Overview
MetLife is a chosen insurance vendor for the NH PFML
program that meets their business needs (within
regulations set by the state). Employers are not required
to participate in the NH PFML program; however,
employees of employers who do not participate are
eligible to opt in individually, and employers with 50+
workers must collect and remit premium payment
through payroll deductions. Employers must restore
workers to the position they held prior to leave and
continue to provide health insurance during leave, with
workers paying any shared costs.
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Overview
The Washington Paid Family and Medical Leave
(WA PFML) program became effective January 1,
2020. The program provides paid time off benefits
when an worker employee experiences a serious
health condition that prevents them from working
or when time is needed to care for a family
member, bond with a new child or spend time
with a family member preparing for military
service overseas. In general, WA workers are
eligible for up to 12 weeks of PFML leave per year.
Workers may qualify for up to 16 weeks of PFML if
they have more than one qualifying event.
Washington Paid Family Leave
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Overview
If someone experiences a condition in pregnancy
or birth that results in incapacity, they may be
eligible for up to 18 weeks of paid leave. The
maximum amount of combined family and
medical leave that an individual may take is 18
weeks per benefit year.
Washington PFML is funded through premiums
paid by both employee and employers. The
premium rate is subject to change annually.
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Overview
Eligible employees can receive up to 90% of their
weekly pay subject to a maximum weekly benefit.
The maximum weekly benefit is recalculated
annually as it is based on the state’s average
weekly wage. Employees can take their leave on an
intermittent basis or all at once.
90% up to 50% of statewide average weekly wage
then 50% of remaining earnings to maximum
benefit amount.
The benefits received a max benefit of
$1427/week.
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Overview
District of Columbia PFML
On July 1, 2020 the District of Columbia began
administering paid leave benefits. The program provides
paid time off when a worker experiences a serious health
condition (including pregnancy), needs to care for a
family member with a serious health condition or bond
with a child. In general, DC workers are eligible for up to
a maximum of 12 weeks of PFML leave per benefit year.
Workers may qualify for an additional 2 weeks for
prenatal medical care leave. DC Paid Family and
Medical Leave is funded through payroll tax and is paid
entirely by employers. The premium rate is subject to
change annually.
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Overview
District of Columbia PFML
Eligible employees can receive up to 90% of their average
weekly wage for a covered leave up to a maximum benefit
of $1,049 for 2023. The maximum weekly benefit is
recalculated annually as it is based on the state’s average
weekly wage. Workers can take leave on an intermittent
basis or all at once.
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Overview
The California Paid Leave Program became
effective January 1, 2004. The program provides
paid time off benefits when an eligible worker
experiences a non-work-related disability under
California State Disability Insurance. The
maximum leave period in a 12-month period for a
workers own disability is 52 weeks.
The program also provides paid Family Leave
benefits to eligible workers to care for a seriously
ill family member, bond with a new child or spend
time with a family member preparing for active
duty military service.
In effect no private options
California Paid Family Leave
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Overview
The maximum leave period in a 12-month period
for Paid Family Leave benefits is 8 weeks. An
eligible employee can receive benefits of 60 – 70%
of their weekly wages earned during a specified
period. The program is funded through employee
payroll contributions; however, employers can
choose to pay for their employees’ contributions.
The contribution rate and wage cap is recalculated
annually and is subject to change. The maximum
weekly benefit is also calculated annually and is
subject to change. The benefits received a max
benefit of $1,620/week. Effective Jan-1-24 CA will
remove the wage cap entirely.
California Paid Family Leave
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Overview
Rhode Island Paid Family Leave
The Rhode Island Leave program provides 2 covered
leaves: Temporary Disability Insurance – TDI (for
medical leaves) and Temporary Caregiver Insurance –
TCI (for family leaves). TDI is income support for eligible
workers out of work for non-work related illness or
injury; TCI is income support for eligible workers out of
work to care for a seriously ill covered family member or
to bond with a newborn, adopted or foster child.
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Overview
Temporary Disability and Temporary Care Insurance are
both funded entirely through worker payroll deduction.
Contribution rate and wage maximums for calculation
are recalculated annually and subject to change. There is
no waiting period for TDI/TCI; however, the worker must
be unable to work for at least 7 days. For Medical (TDI)
the maximum Leave Duration in a 52-week period is 30
weeks. For Family (TCI) the Maximum Leave Duration in
a 52-week period is 6 weeks. Leaves can be taken on an
intermittent or all at once basis.
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Overview
The weekly maximum benefit is 4.62% of the wages
earned in the highest quarter of the base period and
employees with dependents have a different maximum
benefit than those without dependents. The benefits
received a max benefit of $1,007 and with max (5)
dependents $1,359/week.
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Overview
Oregon joins the many states with a paid family
and medical leave plan set to go into effect in
2023. Employers must remit premiums for
Oregon Paid Leave by January 1, 2023, and
employees can claim benefits starting September
3, 2023.
Benefits vary based on the state average weekly
wage and the employee’s average weekly wage, but
cannot be less than 5% of the SAWW or more than
120% of the SAWW. Oregon business owners will
have the opportunity to write an equivalent plan,
approved by the state, through a private carrier.
Coming Soon
Oregon Paid Family Leave PFMLI

Overview
Colorado recently announced its FAMLI (Family
and Medical Leave Insurance) program, which
will be fully rolled out by 2024. Employers are to
begin deducting premiums in January 2023.
Colorado workers can receive between 37% and
90% of their average weekly wage, depending on
their income level. The benefit will max out at
$13,200 annually in 2024.
$1100 is the max weekly benefit
Coming Soon
Colorado Paid Family Leave PFMLI

Coming Soon
Overview
Vermont PFML
On December 6, 2022, Vermont Governor Phil Scott
announced that the state will launch a voluntary Paid
Family and Medical Leave program that will provide
workers in the state with such leave insurance by 2025.
The Vermont Family and Medical Leave Insurance Plan
(VT-FMLI) will start being offered to state employees in
July 2023, and then will be rolled out to other private
employers and employees over the next two years.
Under the first phase of the plan, Vermont state
employees will be able to receive 60% wage replacement
for up to 6 weeks beginning in July 2023.
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Coming Soon
Overview
Vermont PFML
Qualified events are the birth of a child, care of a
newborn, or foster or adoptive child placement up to one
year after birth or placement; care for an eligible
worker's covered family member; the employee's own
serious health condition; and a qualifying military
exigency for a covered family member.
Vermont has partnered with the chosen insurance carrier
vendor, The Hartford, to develop the program.
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Coming Soon
Overview
Vermont PFML
The program will be rolled out in 3 phases. Phase I will
begin for Vermont state employee on July 1, 2023. Phase
II, beginning on July 1, 2024, will expand to include
other private and non-state public employees with two or
more employees on a voluntary basis. Phase III,
beginning on July 1, 2025, for employees whose employer
does not offer VT-FMLI, self-employed individuals, and
employers with one employee will be able to purchase
coverage through the program through an individual
purchasing pool.
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Coming Soon
Overview
Delaware PFML
On May 10, 2022, Governor John Carney signed the
Healthy Delaware Families Act into law. The program
will provide eligible Delaware workers job-protected paid
leave benefits for up to 12 weeks for parental leave every
year and up to a combined six weeks every two years for
employees own serious medical needs, care of family
members and military exigency. Except for parental leave
benefits, an employee is only eligible for benefits once in
a 24-month period. Contributions are set to begin on
January 1, 2025 with benefits set to begin on January 1,
2026. More updates will be provided as developments in
the program occur.

Coming Soon
Overview
Maryland PFML
The Maryland General Assembly voted to enact Senate Bill
275, the Time to Care Act of 2022 (“Act”), creating a paid
family and medical leave program for covered workers in the
state of Maryland. Contributions are set to begin on October 1,
2023, and benefits are set to begin on January 1, 2025.
Eligible workers are expected to be eligible for up to 12 weeks
of paid time off to care for their own medical need, care for a
family member with a serious health condition, bonding or
placement of a child along with addressing needs related to
military deployment. Maryland has posted that more updates
should be available after June 1, 2023. More updates will be
provided as developments in this program occur. Maryland
passed a bill awaiting Governor's signature to delay this
program so contributions begin 10/1/24 and benefits on
1/1/26

Overview
The Hawaii TDI law was enacted in 1969, which
requires employers to provide partial “wage
replacement” insurance coverage to their eligible
employees for nonwork-related injury or sickness,
including pregnancy.
The law provides eligible employees with up to 26
weeks of wage replacement per benefit year.
Hawaii TDI is funded through contributions and
can be funded entirely by employers or shared
between employers and employees;
Short Term Disability, No Paid Leave
Hawaii TDI
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Overview
However, employee contributions cannot exceed
0.5% or one-half of total premium weekly
deduction based on the state’s base wage of
$1,318.48 for 2023.
Eligible employees can receive up to 58% of their
average weekly wage rounded to the next higher
dollar up to a maximum of $765 for 2023. The
maximum weekly benefit is recalculated annually
as it is based on the state’s average weekly wage.
Short Term Disability, No Paid Leave
Hawaii TDI
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Providing Care
Close and continuing proximity
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

NY Family Member
Family member means a child, parent, grandparent, grandchild, spouse, or
domestic partner
Child means a biological, adopted, or foster son or daughter, a stepson or
stepdaughter, a legal ward, a son or daughter of a domestic partner, or the person to
whom the employee stands in loco parentis.
Parent means a biological, foster, or adoptive parent, a parent-in-law, a
stepparent, a legal guardian, or other person who stood in loco parentis to the
employee when the employee was a child
Grandparent means a parent of the employee's parent
Grandchild means a child of the employee's child
Spouse/Domestic Partner
Sibling

Medical Certification
Health Care Provider information
Date commenced/Probable duration
Certification of patients health condition
– Must include diagnosis codes (ICD-10)
Estimate of frequency and duration of
required leave
Employee’s responsibility to provide
complete information to carrier

Employee Notice
Foreseeable Leave – 30 days notice
Expected birth, placement
Planned medical treatment
Known military exigency
Not foreseeable
“As soon as practicable”
Same or next business day
Advance notice to carrier not required

Military Exigency
As interpreted under FMLA
Spouse, domestic partner, parent, child
Short notice deployment
Financial/Legal arrangements
Counseling
Attend military events/activities
Up to 15 calendar days for R&R leave
Certain childcare activities
Post-deployment activities
Parental care activities
Military caregiver leave (26 weeks)

Collective Bargaining Units
Non-Waiver of Rights
Employees may not waive their rights to Paid Family Leave or to "opt out“
At Least as Favorable
If a different rule is not specified, PFL provisions apply
Employees are entitled to PFL benefits that are at least as favorable as the
benefits provided under the PFL law

Employer Obligations
Collection of premiums
PFL Poster
Handbook information re: PFL
Subject to audit by WCB

Health Insurance
Continuation on same terms as if he/she had continued to work
Employee contribution must continue obligation ceases if payment is more than 30
days late 15-day notice
With our online application process, you can BIND DBL / PFL
without ever having to leave your home. Plus, our team of experts is
always here to assist you if you have any questions or concerns. Apply
now and get the coverage you need today.

Reinstatement
Employees returning from leave are
entitled…to the position of employment
held by the employee when the leave
commenced, or to be restored to a
comparable position with comparable
employment benefits, pay and other
terms and conditions of employment.

Discrimination/Retaliation
It shall be unlawful for any employer or his or her duly
authorized agent to discharge or in any other manner
discriminate against an employee as to his or her
employment because such employee has claimed or
attempted to claim compensation from such employer,
or because he or she has testified or is about to testify in
a proceeding under this chapter and no other valid
reason is shown to exist for such action by the employer.

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State Disability & Paid Family Leave Reference Guide

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