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 must then work with your insurance carrier to complete the Massachusetts Paid Family and Medical Leave Confirmation of Insurance form.
The Confirmation of Insurance form 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.
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 to work directly with your insurance carrier to complete a Massachusetts Paid Family and Medical Leave Confirmation of Insurance form.
If you are applying for a paid leave exemption for multiple entities, learn more about exemption information for multi-entity employers .
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 carriers, you must attach a new completed Massachusetts Paid Family and Medical Leave Confirmation of Insurance form with the new carrier information and approved policy form number. You will need to work directly with your insurance carrier to complete the form.
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.
Department of Family and Medical Leave - Hours of operation: Monday-Friday, 8 a.m. - 5 p.m.
Department of Family and Medical Leave - Hours of operation: Monday-Friday, 8 a.m - 5 p.m.
Department of Revenue - Hours of operation: Monday-Friday, 8:30 a.m. - 4:30 p.m.