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Paid Family Leave for Family Care

Paid Family Leave for Family Care
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What is Family Care?

You can take Paid Family Leave to care for a close family member with a serious health condition, including family members outside of New York State.  

Family members include:

  • spouse
  • domestic partner (including same and different gender couples; legal registration not required)
  • child/stepchild and anyone for whom you have legal custody
  • parent/stepparent
  • parent-in-law
  • grandparent
  • grandchild

 

Some important information about Paid Family Leave for family care:

  • If you are serving in the role of a parent for a child (‘in loco parentis’), you may be eligible to take Paid Family Leave for that child. You are 'in loco parentis' when you are fully responsible for the child's day-to-day care and financial support even if you are not legally or biologically related to the child, Similarly, if someone stood ‘in loco parentis’ to you when you were a child, you may be able to take leave to care for them. Your insurer may ask for a simple statement of the parental relationship or for other reasonable documentation to demonstrate how you stand in loco parentis to the child or how the person in need of care stood in loco parentis to you when you were a child.
  • The Paid Family Leave definition of serious health condition may include mental health conditions.
  • Your employer’s insurance carrier will receive and process requests for Paid Family Leave, and make your benefit payments.

 

In 2019, you may be eligible to take up to 10 weeks of Paid Family Leave.  See below for complete instructions on how to apply.

 

Estimate your Paid Family Leave benefits

 WAge Benefits Calculator

What is a Serious Health Condition?

A serious health condition is an illness, injury, impairment, or physical or mental condition that involves:

  • inpatient care in a hospital, hospice, or residential health care facility; or
  • continuing treatment or continuing supervision by a health care provider.

 

Examples of Reasons for Continuing Treatment or Supervision
REASON EXAMPLES
Chronic serious health condition that continues over an extended period, requires periodic treatment visits, and may cause episodic periods of incapacity Asthma, diabetes, epilepsy, psychosis, schizophrenia, bipolar disorder, or post-traumatic stress disorder (PTSD)
Long-term or permanent period of treatment that may not be effective and the family member is under continuing supervision Alzheimer’s disease, severe stroke, or terminal stage of a disease
Treatment or recovery from restorative surgery after an accident or other injury, or a condition that would likely result in a period of incapacity of more than three consecutive full days in the absence of treatment Cancer (chemotherapy and radiation), severe arthritis (physical therapy), or kidney disease (dialysis)
A period of more than three consecutive full days involving treatment two or more times by a health care provider or treatment on at least one occasion followed by continuing treatment under supervision A course of prescription medication as a regimen of continuing treatment or treatment for a substance use disorder

 

For example, you need one or more full days to care for your mom when she undergoes chemotherapy; or your dad is having surgery followed by extensive recuperation; or your child is undergoing intense psychotherapy and is unable to attend school for a period of time; or a family member is seeking treatment for a substance use disorder. These are situations that may qualify for Paid Family Leave if certified by a licensed health care provider. These examples are used for illustration purposes only and are not intended to pre-determine your eligibility for Paid Family Leave; only the Paid Family Leave insurer can make eligibility determinations.

Cosmetic treatments (such as plastic surgery) are not eligible conditions unless inpatient hospital care is required or complications develop. Ordinarily, unless complications arise, the common cold, the flu, ear aches, upset stomach, minor ulcers, headaches other than migraine, routine dental or orthodontia problems, periodontal disease, etc., are examples of conditions that do not meet the definition of a serious health condition and would not qualify for Paid Family Leave.

Who Can Certify Health Conditions?

The following Licensed Health Care Providers may complete necessary documentation for Paid Family Leave within their scope of practice:

  • Physician
  • Physician Assistant
  • Chiropractor
  • Dentist
  • Physical Therapist
  • Nurse Practitioner
  • Registered Professional Nurse
  • Podiatrist
  • Optometrist
  • Psychologist
  • Clinical Social Worker
  • Occupational Therapist
  • Midwife
  • Mental Health Practitioner
  • Speech-language Pathologists
  • Audiologists

 

Health care providers outside of New York, including outside the United States, who are certifying that an employee's request for Paid Family Leave is medically justified must have a valid license in the state or country where they practice.

How to Apply

Requesting Paid Family Leave is easy. Start by planning your leave:

  • Leave can be taken either all at once or intermittently, but must be taken in full-day increments. Note: If you take intermittent leave and more than three months pass between days of Paid Family Leave, your next day or period of PFL is considered a new claim under the law. This means you will need to submit a new Request for Paid Family Leave.
  • You must notify your employer at least 30 days before the start of leave if foreseeable; otherwise, notify them as soon as possible.
  • Employees who hold more than one job may take Paid Family Leave from both jobs, but they must do so with both employers at the same time.

 

Once you're ready to apply, follow these three steps:

  1. COLLECT YOUR FORMS AND DOCUMENTATION
    The forms are available from your employer, employer’s insurance carrier or you may download: Care for a Family Member with a Serious Health Condition (Forms PFL-1, PFL-3 & PFL-4)

    Required Forms
    The form package for bonding leave includes the following forms:
    Request for Paid Family Leave (Form PFL-1)
    Release of Personal Health Information Under the Paid Family Leave Law (Form PFL-3)

    Health Care Provider Certification for Care Of Family Member with Serious Health Condition (Form PFL-4)
     
  2. COMPLETE
    • FORM PFL-1
      Form PFL-1 has sections that need to be completed by you and by your employer.
      1. Fill out your section.
      2. Make a copy and give the form to your employer.
        • Your employer is required to return Form PFL-1 to you within three business days.
        • If your employer fails to return the form to you, submit the Form PFL-1 that you have filled out, along with the rest of your request package, to your employer’s insurance carrier.
           
    • FORM PFL-3
      Your family member (the care recipient) completes Form PFL-3 and submits the form to their health care provider to keep on file.

      This form authorizes a health care provider to release information regarding your family member’s serious health condition to your employer’s insurance carrier. Do not send this form to the insurance carrier.
       
    • FORM PFL-4
      Form PFL-4 has sections that need to be completed by you and by your family member’s health care provider.
      Fill out your section, make a copy and give the form to the health care provider. Ask the provider to complete their portion of the form and return it to you in a timely manner.
       
  3. SUBMIT TO INSURANCE CARRIER
    You must submit your completed request package to your employer's insurance carrier within 30 days after the start of your leave to avoid losing benefits.

    If you cannot get documentation to support a leave request within this timeframe, the insurance carrier can deny the request. 

    Mail or fax your Form PFL-1, Form PFL-4, and all supporting documentation to your employer’s insurance carrier.

    To find out who your employer’s insurance carrier is, you can:
    • Look for the Paid Family Leave poster in your workplace.
    • Ask your employer.
    • Search your employer’s name to look up their insurance carrier.

 

Employer Search

 

If you cannot find your employer’s insurance carrier, call the Paid Family Leave Helpline for assistance: (844) 337-6303. The Helpline is available Monday through Friday, 8:30 a.m. to 4:30 p.m.

If you believe your employer is uninsured, you can submit your request for Paid Family Leave to the NYS Workers’ Compensation Board:

NYS Workers’ Compensation Board
Paid Family Leave
PO Box 9030,
Endicott, NY 13761-9030
 

In most cases, the insurance carrier must pay or deny benefits within 18 calendar days of receiving your completed request or your first day of leave, whichever is later. Your request cannot be considered incomplete solely because your employer failed to fill out Form PFL-1 Part B within three business days.

If you have a question regarding the status of your request, contact your employer's insurance carrier.

 

If you disagree with the insurance carrier's decision: 

You may request arbitration for a denial or any other PFL claim-related dispute, such as timeliness of the carrier’s payment. 

Arbitration for Paid Family Leave is handled by NAM (National Arbitration and Mediation).

If you are denied or partially denied for Paid Family Leave, your insurance carrier (or employer, if self-insured) must provide you with the reason for denial and information about requesting arbitration, or you can visit the arbitrator’s website at www.nyspfla.com.

If your request for Paid Family Leave is denied and you have already started your leave, you are not considered to be on Paid Family Leave, and it will be up to your employer to determine how to treat the time off.  

 

 

For details on how to request arbitration view:

Your Rights and Protections

 

If you need further assistance, call the Paid Family Leave Helpline at (844) 337-6303.

Getting Paid

In most cases, the insurance carrier will pay benefits or deny your claim within 18 days of receiving your completed request or your first day of leave, whichever is later. After the initial payment, payments are made biweekly. Your insurance carrier may provide options for how you will be paid, for example, via direct deposit, debit card or paper check.

Note: Pursuant to the Department of Tax Notice No. N-17-12 [PDF], Paid Family Leave benefits are taxable. Taxes will not automatically be withheld from benefits, but employees can request voluntary tax withholding. Questions related to the taxability of Paid Family Leave contributions should be referred to the NYS Department of Taxation and Finance.

Tips for Completing the Forms

If you are planning to request Paid Family Leave to care for a family member with serious health condition, make sure their health care provider completes the Health Care Provider Certification for Care of a Family Member with Serious Health Condition (Form PFL-4) as soon as possible. This form is a required part of your request for Paid Family Leave, so it must be submitted to your employer’s Paid Family Leave insurance carrier within 30 days of the first date you take Paid Family Leave.  

Here are some tips on how you can coordinate with your family member and their health care provider: 

  • With your family member’s permission, accompany them to a visit with their health care provider. Ask the health care provider to complete the certification form and return it to you or your family member within a timely manner.
  • Notify the health care provider that you must submit your completed request to your employer’s insurance carrier within 30 days of the start of your leave or you’ll risk losing Paid Family Leave benefits, so their prompt completion of the form is crucial. 
  • Remind your family member to follow up or ask if you can follow up with their health care provider if you have not received the certification form. 
  • You can help the health care provider complete the form in a timely manner by completing all of the information on the form that is to be filled out by the employee. 

Contact PFL Helpline

For more information, call the Paid Family Leave toll-free helpline Monday-Friday, 8:30am – 4:30pm EST.

Contact us by phone: