Requirements for purchased private paid leave plans

General Information

Employers applying for an exemption with a purchased private plan should obtain a paid leave private plan from an insurance carrier licensed by the Division of Insurance (DOI). Once the plan has been purchased, you will need the policy form number approved by the DOI. This number can usually be found on your paid leave policy in the bottom left corner of the first page. You then must complete the Massachusetts Paid Family and Medical Leave Confirmation of Insured Policy Form Number.   

The Confirmation of Insured Policy Form Number must be signed by both a representative of the employer and a representative of the insurance carrier (electronic signatures are acceptable) and list the insurance carrier’s approved DOI policy form number.  

Additional Resources

PFML Confirmation of Insured Policy Form Number (revised 12/31/20) (fillable)

PFML Confirmation of Insured Policy Form Number (revised 12/31/20)

DOI approved insurance carriers

DOI has a list of  Paid Family Medical Leave Products that are approved to provide paid family and medical leave policies that meet  DFML standards. This list is updated regularly.   

Please note that most long-term and short-term disability insurance policies do not qualify for a medical leave exemption. To be approved for an exemption, 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. 

Learn more about benefit requirements for private paid leave plan exemptions. 

Applying for a purchased private plan exemption

You may apply for an exemption online using your MassTaxConnect account. You will need your Insurance carrier-issued policy form number and a completed Massachusetts Paid Family and Medical Leave Confirmation of Insured Policy Form Number.   

If you are applying for a paid leave exemption for multiple entities, learn more about exemption information for multi-entity employers .   

Additional Resources

PFML Confirmation of Insured Policy Form Number (revised 12/31/20) (fillable)

PFML Confirmation of Insured Policy Form Number (revised 12/31/20)

Reporting a change to your approved exemption

If you are switching insurance carriers or looking to change to a self-insured plan before your exemption renewal period, you must inform the Department at least 30 days prior to the change taking effect. You must send an e-message via your MassTaxConnect account explaining that you are changing insurance carrier or switching to a self-insured plan and attach the required documents.  

If you are switching insurance carrier, you must attach a new completed Massachusetts Paid Family and Medical Leave Confirmation of Insured Policy Form Number with the new carrier information and approved policy form number.   

If you are switching to a self-insured plan, you must obtain and attach a copy of a surety bond running to the Commonwealth of Massachusetts in an amount based upon your Massachusetts workforce size. You also must attach a self-insured insurance declaration document detailing that your plan meets all necessary requirements. Learn more about requirements for self-insured private paid leave plans. 

Additional Resources

PFML Confirmation of Insured Policy Form Number (revised 12/31/20) (fillable)

PFML Confirmation of Insured Policy Form Number (revised 12/31/20)