Insurance carriers' guide to PFML

Learn about Paid Family and Medical Leave (PFML) and how you can help your employer clients comply with the law’s requirements.

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Latest News

The Department of Family and Medical Leave (DFML) has a new form that will be required for an exemption request, the PFML Confirmation of Insurance (COI) form. This form will replace the PFML Confirmation of Insured Policy Form Number form. You, as the insurance carrier, will typically provide a signed form to employers.

Beginning October 1, 2022, DFML will no longer accept the PFML Confirmation of Insured Policy Form Number form. DFML will accept both forms from now until September 30, 2022.

Private plan benefit requirements

The Division of Insurance reviews and acknowledges insurance carriers who provide private medical leave, family leave, or family and medical leave plans that offer paid leave benefits equal to, or more generous than, those provided under the PFML program. 

A private plan must confer all the same or better benefits to its workforce, as those required by M.G.L. c. 175M, sec.11.    

In addition, the private plan must provide equivalent or better rights and protections as those specified in M.G.L. c. 175M, sec. 2 and 9

Key Actions for Private plan benefit requirements

Providing information to your employer clients

Once your insurance plans are approved by the state, there is certain information you must provide employers who contract with you to provide paid leave coverage. 

Employer clients will need the policy form number approved by DOI to complete the Massachusetts Paid Family and Medical Leave Confirmation of Insurance form. The employer needs this completed form to apply for an exemption from making PFML contributions. 

  • Both you, the insurer, and the employer must sign the form 
  • The employer’s legal business name must be listed 

An employer with multiple businesses with separate federal Employer Identification Numbers (EINs) must apply for an exemption for each business. They can use the same Confirmation of Insured Policy Form Number for more than one business as long as the employer confirms that all businesses listed are covered under the paid leave plan.

For additional guidance, send employers to:

Applying for an exemption

Employers who contract with you for a private plan must apply for an exemption from making PFML contributions through the Department of Revenue’s (DOR) MassTaxConnect, and the exemption must be renewed annually or by the expiration date, whichever comes sooner. Your employer clients must submit the application, not the insurance carrier or broker. 

The application must be submitted and approved in the quarter prior to the exemption effective date. For example, if the effective date is Jan. 1, the application period is October-December. 

The employer must submit separate applications for each business that has its own EIN and a Massachusetts workforce.   

You can share with your clients step-by-step instructions on how to apply for an exemption with MassTaxConnect

Employers applying for an exemption will receive an email notification that a decision has been made within 5 business days. If the application is incomplete the Department will reach out to the point of contact listed on the exemption application and request missing information. Employers can log in to MassTaxConnect to review the decision. 

Informing employees

Employers who are switching between PFML and a private plan should inform their employees at least 30 days before the effective date of the private plan. 

In addition, employers must provide written notice to their workforce of paid leave benefits, contribution rates, and other provisions as outlined in M.G.L. c. 175M sec. 4. Contribution rates and benefit amounts are updated annually. 

A workplace poster prepared or approved by DFML that explains the benefits available to employees under PFML law must be displayed in the workplace in a location where it can be easily read. 

Annual renewal of private plans

Employers who plan to continue contracting with you for a private plan must renew their exemption by its expiration date. In most cases, the exemption period is for 4 quarters.  You, as the carrier, are required to provide the correct documentation to support your customer's MA PFML private plan exemption.

To renew an exemption, the employer must submit a new exemption application online through MassTaxConnect. Employers must apply for renewal in the quarter prior to the exemption’s expiration date. For example, if the exemption expires Dec. 31, apply between October and December. 

A new Confirmation of Insurance form must be submitted, with updated signatures from both you, the insurance carrier, and the employer. 

Key Actions for Annual renewal of private plans

Insurance Carrier Cancellations

  • When a policy is terminated with an employer, DFML requests that, you, as the insurance carrier, notify DFML by filling out the Insurance Carrier Cancellation form.
  • In situations where an employer has been terminated for nonpayment of premiums but subsequently cures the nonpayment status with the insurance carrier AND DFML was notified of the initial termination, the following steps should occur:
    • The insurance carrier should contact DFML to inform them that the coverage for an employer was cured with no lapse in coverage.
    • If needed, DFML will respond advising the insurance carrier of any follow up steps that are required by the employer (i.e. submitting an exemption request).
    • If DFML paid out any claims, those claims will be cancelled and the overpayment will be requested from the insurance carrier. 
  • The employer who is switching from a private plan to PFML should: 
    • Inform the Department that they will not be renewing by completing this form
    • Give employees 30 days’ notice that the private plan is ending so employees can submit applications under the appropriate plan  

Learn more about the steps employers should take when switching from a private plan to PFML

Key Actions for Insurance Carrier Cancellations

PFML Leave Statute and Regulations

Learn more about the Department of Family and Medical Leave regulations (458 CMR 2.00). The regulations were finalized as of July 24, 2020 and updated December 21, 2020.

 

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