Benefit requirements for private paid leave plan exemptions

To be eligible for an exemption, employers must offer an approved private plan with paid leave benefits that are equal to or more generous than those provided under the Paid Family and Medical Leave (PFML) program. Exemptions are only available to employers, not individuals.

Updated February 27, 2025.

General overview

Massachusetts employers with a qualifying paid leave benefit plan may be eligible for an exemption from making Paid Family and Medical Leave (PFML) contributions.

Learn how to apply for a PFML employer exemption.

Certain employers are automatically excluded and do not need to apply for an exemption.  

There are two types of private paid leave plans: 

• Purchased private paid leave plans 
• Self-insured private paid leave plans 

Legal Requirements for Private PFML Plan Benefits

An employer’s PFML private plan must, among other things:

1. Confer at least all the same rights, protections, and benefits provided to employees and former employees under M.G.L. c. 175M (the PFML law). This means your approved plan must meet all the minimum requirements listed below and must not cost your workers more than they would be required to contribute to the state plan under the paid leave law.
   1. Example: When a healthcare provider has determined that an employee needs 12 weeks of medical leave for recovery from childbirth and the employee is eligible for a leave of that duration, the employer or its private plan insurance provider cannot unilaterally reduce the leave allotment to 8 weeks.
2. Cover unemployed former employees who apply for leave benefits for up to 26 weeks after separation from employment, or until they obtain other employment, whichever is sooner.
3. Comply with workplace notice requirements that include sharing instructions on how to apply for benefits. It is an employer's duty under M.G.L. c. 175M, sec. 4 to display workplace posters about the PFML law and provide your workforce with written notice of PFML benefits, contribution rates, and other provisions.   
4. Process applications for leave benefits filed by employees and former employees. This process must include an opportunity to appeal a decision on the application to the private plan before issuing a decision that can be appealed to DFML.

Minimum family leave benefit requirements

To qualify for an exemption from family leave contributions, your private plan must provide the following:  

• All covered individuals (full-time, part-time, permanent, or seasonal) are eligible for family leave benefits  
• A weekly paid benefit amount that is greater than or equal to the benefit provided by the Paid Family and Medical Leave program 
• A minimum of 26 weeks of paid leave during the benefit year to provide care to a family member, as defined by paid leave law, with a serious health condition suffered while on active duty in the armed forces  
• A minimum of 12 weeks of paid leave during the benefit year if their spouse, child, or parent is a current member of the Armed Forces (including the National Guard and reserves) and is on covered active duty or notified of an impending call or order to covered active duty  
• A minimum of 12 weeks of paid leave during the benefit year to provide care to a family member, as defined by paid leave law, with a serious health condition  
• A minimum of 12 weeks of paid leave during the benefit year to bond with a child during the first 12 months after a child’s birth, or the first 12 months after adoption or foster placement of a child under the age of 18  
• Job protection while the covered individual is on qualified leave  
• Continued employer contributions to employment-related health insurance benefits, if any, at the level and under the conditions coverage would have been provided if the covered individual had continued working continuously for the duration of qualified leave  
• Leave may be taken intermittently or on a reduced leave schedule, with the weekly benefit amount being prorated  
• Your plan specifically states that all presumptions shall be made in favor of the availability of leave and the payment of leave benefits  

Minimum medical leave benefit requirements

To qualify for an exemption from medical leave contributions, your private plan must provide the following:  

• All covered individuals (full-time, part-time, permanent, or seasonal) are eligible for medical leave benefits  
• A minimum of 20 weeks of paid medical leave in a benefit year if a covered individual is unable to work due to a serious health condition  
• A weekly paid benefit amount that is greater than or equal to the benefit provided by the Paid Family and Medical Leave program 
• Job protection while the covered individual is on qualified leave  
• Continued employer contributions to employment-related health insurance benefits, if any, at the level and under the conditions coverage would have been provided if the covered individual had continued working continuously for the duration of qualified leave  
• Leave may be taken intermittently or on a reduced leave schedule if medically necessary, with the weekly benefit amount being prorated  
• Your plan specifically states that all presumptions shall be made in favor of the availability of leave and the payment of leave benefits

Legal Requirements for PFML Notices

Notices issued to employees of employers with private plans must comply under 801 CMR 1.02(6). Notices of an action to approve, deny, terminate, reduce, or suspend benefits to an applicant must include, but not be limited to:

1. Clear and plain statement of the action to be taken
2. The date on which the action shall become effective
3. An explanation of reasons for the action
4. The regulation or other legal authority on which such action is based
5. The telephone number and address where further information may be obtained
6. An explanation of the applicant's or recipient's right to request a hearing (including the time limits and manner for request)
7. A copy of the form used to request a hearing
8. An explanation of the circumstances, if any, under which benefits or services will continue pending an adjudicatory proceeding
9. An explanation of the right to be represented, including if applicable, the availability of assistance
10. The mailing address, telephone number and office hours of the office responsible for receiving and/or hearing appeals

Providing top off benefits

Effective November 1, 2023, if you have a private plan exemption for family and/or medical leave, your self-funded private plan or insurance provider must provide the option for your employees to top off their benefit amount using employer provided PTO.  

Learn more about top off benefits