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MA Paid Family & Medical Leave 2021What Customers Needs to Know
Information is for general informational purposes only and does not constitute legal advice. It does not purport to be complete or to cover every situation. You must consult with your own legal advisors to determine how the Massachusetts Paid Family and Medical Leave law affects you.
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Agenda
1. Comparing state and MetLife Solution options
2. Employer obligations and the timeline for participating in the claims process
3. Best practices for benefit overlap and coordination
4. How to respond to questions from employees, carriers and the state
5. Tools & Resources
6. Q&A
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Benefit Plan Design
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Here are the MA PFML Benefits
Max 26 weeks per year
Starting January 1, 2021 Starting July 1, 2021
12 weeksChild Bonding
Military Exigency
20 weeksEmployee’s own Serious
Health Condition
26 weeksMilitary Caregiver
12 weeksCare of Family Member with a Serious Health Condition
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Foundation for MA PFML
Purpose State Run Program MetLife Solution Options
Paid leave & job protection:• Employee’s serious health
condition• Bond with a new child• Care for a seriously ill family
member• Qualifying military events
Department of Family and Medical Leave (DFML) oversees the state program
• Insured by a carrier• Self-insured
Contribution exemption
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Eligibility for MA PFML Benefits
*https://www.mass.gov/info-details/whos-a-covered-individual-under-the-pfml-law
Employees Other Workers
• Full time • Part-time • Seasonal
• Former employees (26 weeks)• Covered contractors (if they’re more than 50%
of your workforce)• Applies to 1099 Contractors who are NOT independent
contractors under MA law*
Covered Entities – Virtually all Employers
Covered Individuals – Financial Eligibility
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Contribution Amounts:• Medical Leave: 0.62% (employer pays 60% &
employee pays 40%)• Family Leave: 0.13% (employee pays 100%)• Total: 0.75%
MA PFML is funded by Workers and Employers State Plan Option
Employers with
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Life of a Claim
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Meet Beverly
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Employees must notify employer of leave
Which notice rules apply?• 30 days is the default• As soon as practicable if delay out of Beverly’s control• Mutually agree on leave dates if you can
Beverly tells her Manager that she is pregnant
Best Practices
Add instructions for notice requirements to your normal leave policies and procedures
Add a copy of the state’s Employee Notice to your website
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Employees need to apply for MA PFML
Both the state and MetLife Solution will ask similar questions to prove the need for leave
State Plan• Application for state benefits only MetLife Solution
• Coordinate state plans with other benefits• Paid parental leave• FMLA
Separately• File for company benefits• FMLA
Beverly applies for MA PFML benefits
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Employers must participate in the claim process
Within 10 business daysEmployers need to reply to state with employment details supporting the claim
Best Practice Recommendations
State Plan:• Update your company’s MA State Contacts for
leave administration• Create a template for repeatable information
• Job Descriptions• Company paid leave benefits
MetLife Solution:• Provide Tip Sheet for company benefits
that may overlap
https://www.mass.gov/forms/leave-administrator-contact-information
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Calculating Beverly’s Leave Allotment
Step 1How many PFML days available based on work schedule
Step 2How many PFML days have already been used?
Step 3How many days does the certification allow?
Beverly works 5 days per week
Step 1: 130 days
Step 2: 0 days
Step 3: 30 days for PML + 60 days for PFL
Total: 18 weeks (90 days) for childbirth and bonding
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Calculating Beverly’s Benefit Amount
Step 180% of the first 50% of the State’s Average Weekly Wage (“SAWW”) considering wages from all sources
Step 250% of the amount above 50% of SAWW
Step 3Combine Steps 1+2, up to cap
The state has a benefit calculation formula:
Beverly earns $1,000/week
Weekly Benefit: $ 723.17
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MA PFML benefit payments may be reduced
The complete l ist can be found on the State’s website
Other Income received may lower the MA PFML benefit:
Government programs (unemployment, workers’ comp)
LTD programs
PFML taken during the benefit year
STD, internal PFML policy, other wages, sometimes
State Plan
The state may verify the employee did not make more than 100% of wages during a claim
https://www.mass.gov/info-details/paid-family-and-medical-leave-pfml-benefit-reductions
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Employers can coordinate multiple benefits
Beverly qualifies for her employer’s parental leave policy, which offers 10 weeks of salary continuation: • 6 weeks medical leave and • 4 weeks paid parental leave
How to coordinate Beverly’s benefits:• Weeks 1 – 10: Full wages from employer+ job protection from MA and FMLA• Weeks 11 – 18: $723.17/week; job protected
Accruedleaves vs.
Non-accrued leaves Beverly’s employer:• Qualifies for MA PFML Reimbursement
• Will run FMLA concurrently
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What happens once a claim is approved
Beverly only has 1 waiting periodBeverly returns to work as expected after 18 consecutive weeks.
Extension of Benefits: Requires new application
Applied to the first 7 calendar days of the leave (2 exceptions)
Waiting Period
Can be part of the Return to Work plan
Fit for Duty
State will ask employer for additional approval details
State to Employer
Employer must respond within 10 business days
Employer to State
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Own or family member’s serious health condition: only when medically necessary
• Bonding: only if the employer and employee mutually agree
• Qualifying Exigency: when requested
Medical
Family Leave
When intermittent and reduced schedule leaves may apply
Former employees may also take MA PFML intermittently or on a reduced schedule
Add your minimum intermittent leave increment allowed for each leave type to your company benefit site and handbook
Best Practice
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Employers can manage absences
Intermittent and reduced leave schedules should be documented so you can manage absences
An employee who does not follow the schedule/fails to work during times agreedto may be subject to employer discipline
Employer can contact the plan administrator if the employee fails to adhere to the agreed up on intermittent/reduced leave schedule
This would not be considered retaliatory per the regulations
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What is the Appeals Process?
* Assumes MetLife Solution follows the same timeframes as the state
Individuals and employers notified
Individual can appeal
Decision issued
District Court complaint
Decision 10 Days 30 Days 30 Days
Individuals and employers notified
Decision
Individual can appeal
10 Days
Decision issued
30 Days
State Plan
MetLife Solution*1st Round of Appeals
If needed, 2nd round appeal with state
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Program at a GlanceIn Summary
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MA PFML benefits
Weekly benefit payment is a percent of wages up to a maximum12 Weeks• Child Bonding• Military Exigency• Care of Family (7/1/2021)
20 WeeksEmployee’s own Serious Health Condition
26 Weeks• Military Caregiver• Total Combined Family
& Medical
Benefit Calculation:
+80% benefit on 50% of the state average weekly wage 50% on the balance up to cap
$850 maximum weekly cap for 2021
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Claim administration timeline
Decision Benefit PaymentsEmployer
Response SentApply for Benefits
Send Employer Verification
Employee State/Administrator Employer State/Administrator
30-60 days in advance
Within 5 days of
receiving
Within 10 days of receiving request from Administrator
Within 14 days of receiving all materials
Within 14 days of approval or first
absence date
• If delay is out of the employee’s control, notice as soon as practicable
• Filing on behalf of employee may be allowed when approved by DFML
• MetLife Solution has flexibility for obtaining information
• Employer has option to weigh in on worker’s request
• May set up reimbursement if applicable
• Employee and employer be notified of the decision
• If denied an appeal process is available
• MetLife Solution will have appeals at both plan level and state level
• If employee is overpaid, they will have to repay the DFML within 30 days
• Employers may be required to send monthly reports to assist state in payment tracking
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Checklist: Info the state may request from employers
State Plan: Within 10 business days of receiving a request for information, employers needto confirm the following employment information with the state so they can adjudicate a claim:
Last 12 months’ wages and/or earnings information
Job description
Work schedule (full time or part-time and weekly hours worked)
Prior requests/approvals for a qualifying reason
The amount of paid leave already taken
Description of the employer’s paid leave policies and if the employee used/plans to use leave during the PFML period
Whether the employee applied for FMLA or other concurrent leave and whether the employer approved the application
Other wage replacement benefits the employee will receive and any other relevant information, such as evidence of fraud
Potential consequence for not responding: Per the regulations, the state may deem the application complete, which triggers the state’s deadline to determine the claim.
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Other Leaves that may overlap with MA PFML
Benefit Paid/Unpaid Offset MA PFMLImpact to Employer
Sponsored Plan
Unpaid/Job protected or Paid/Job protected
Will subtract either time or paid benefits from MA PFML entitlement
Benefits can be offset or reimbursed due to overlapping benefits
Federal FMLA –Medical Leave, Child Bonding, Military Unpaid Yes N/A
Federal FMLA –Care Family Member –Child, Spouse, Parent Unpaid Yes N/A
Federal FMLA –Care Family Member – other family Not applicable No N/A
Company Sponsored Paid Maternity/Bonding/Salary Continuation (non accrued leaves)
Paid Maybe MA PFML Reimbursement possible
Company’s Short-Term Disability Paid Maybe Company STD offset possible
Company PTO for a MA PFML qualifying reason Paid Yes• No: Accrued leave paid 100%;
Job protection only• Maybe: Top up supplement
MA State Sick Leave/Employer Sick Leave Paid Maybe No (accrued leave pays 100%)Job protection only
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Helpful Links:• MetLife’s PFML Microsite• Massachusetts State PFML Website
Best Practices:• Research MA PFML using trusted sources • Beware of scammers as on-line claim process is available for claim details
Tools & Resources
www.metlife.com/PFML
https://www.mass.gov/orgs/department-of-family-and-medical-leave
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MA Paid Family & Medical Leave 2021AgendaSlide Number 3Here are the MA PFML BenefitsFoundation for MA PFMLEligibility for MA PFML BenefitsMA PFML is funded by Workers and EmployersSlide Number 8Slide Number 9Employees must notify employer of leaveEmployees need to apply for MA PFMLEmployers must participate in the claim processCalculating Beverly’s Leave AllotmentCalculating Beverly’s Benefit AmountMA PFML benefit payments may be reduced Employers can coordinate multiple benefitsWhat happens once a claim is approvedWhen intermittent and reduced schedule leaves may applyEmployers can manage absencesWhat is the Appeals Process?�Slide Number 21MA PFML benefitsClaim administration timelineChecklist: Info the state may request from employersOther Leaves that may overlap with MA PFMLTools & ResourcesSlide Number 27