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Switching between private plans and Paid Family and Medical Leave (PFML)

Learn more about your responsibilities when switching from a private plan to PFML and vice-versa.

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Switching between private plans and PFML

Under the PFML Program, it is possible to switch coverage between the state and a private plan and vice versa. It is also possible for you to have an approved private plan exemption for medical leave benefits but participate in the state program for family leave benefits (or vice versa).

Employers who are transitioning between plans must notify their employees and DFML no later than 30 calendar days prior to their private plan termination date. A delay in informing their employees and DFML may result in application delays for their employees.

Changing to PFML

If you are switching to PFML, it is imperative that you inform the Department of Family and Medical Leave (DFML) as soon as possible to avoid any problems with claims filed by your employees seeking benefits. To inform DFML that you will be moving to Paid Family and Medical Leave, you must complete this form.

In addition, you will need to create an DFML employer account and register a verified leave administrator. In order to verify your DFML employer account and approve claims in our system, you will need to have filed a contributions return in MassTaxConnect and sent a contribution for Paid Family and Medical Leave (PFML). If you are a newly formed employer or switching to PFML from a private plan, your organization may not have made contributions to the PFML Trust Fund.

Follow these instructions to file a contribution with your PFML DOR account (even if it is partial) in order to verify your account. If you need additional assistance accessing and rectifying your MassTaxConnect account for PFML, call the DOR Customer Care Center at 617-466-3950.

Once a tax return has been filed, the contribution amount should be posted within 1-2 business days. At that time, you can use the contribution amount to verify your account.

How you are affected when moving to PFML

  • Exemption terms and penalties
    • If you have completed 12 consecutive months or more of an exemption, you can opt into the state plan at any time without owing back contributions.  
    • If you have completed less than 12 consecutive months of an exemption and decide to terminate before the 12 month term (exemption expiration date), you WILL owe back contributions to the initial exemption effective date
      • The Department will NOT cover benefits back to the effective date although back contributions will be due.
      • Coverage from the state will begin the first day of the first quarter immediately following the date of the exemption termination. For example, an exemption is effective on 4/1/21. A request is made to terminate the exemption on 11/15/21 in order return to the state plan on 1/1/22. The exemption will be withdrawn back to 4/1/21 and back owed contributions will be due from 4/1/21 through 12/31/21. DFML will begin coverage for employees on 1/1/22 and until that time the employer is liable for coverage.
  • The Department will not approve an exemption for less than 4 consecutive quarters
    • The Department reserves the right to allow for an Employer to terminate an exemption where the term is for less than 4 quarters in order to allow the Employer to align with their carrier’s policy term and the overall term equals at least four quarters.
      • For example: Employer has a private plan exemption that runs from 4/1/21 to 3/31/22.  Employer requests that its private plan exemption expire on 12/31/21 to align with its other business insurance lines which run from 1/1/22 to 12/31/22. Exemption can be updated to end on 12/31/21 in order for renewal to run for four full quarters from 1/1/22.
      • For example: Employer has a partial exemption for medical leave and requests to have a full exemption to include family leave. DFML will update the partial exemption to end early provided the employer applies for a family and medical exemption for four consecutive quarters.

How employee leaves are affected when switching to PFML

  • Employees who apply in advance of their leave will need to apply with the plan providing coverage as of the date the leave starts, and not the plan providing coverage as of the date of the application.
  • Medical leave and family leave to bond with a child are two separate claims and coverage must be analyzed separately, even if the family leave to bond with a child immediately follows the medical leave. Please note that family leaves to bond with a child immediately following medical leaves will still be entitled to waive the waiting week even if the applications are covered by different carriers.
  • Timely-filed extensions are counted as part of the same claim for purposes of determining coverage. Timely-filed extensions are made within 14 days of the end of the leave. The extension must continue immediately from the end of the initial leave. 
  • Intermittent leaves will be covered based on the approved period of intermittent leave and must be covered until the end of the approved period or the end of the benefit year, whichever is soonest.

Changing to a private plan

Employers seeking an exemption from making Paid Family and Medical Leave (PFML) contributions by purchasing a private plan must follow certain guidelines. Learn more about Requirements for purchased private paid leave plans.

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