Paid Family Leave Forms Released

Posted on Posted in Health and Welfare Compliance

The Workers’ Compensation Board released 3 new Paid Family Leave (PFL) forms. 

I have reviewed the forms and am providing details of each below along with a link to download each form.  We continue to monitor both the Workers’ Compensation Board and Department of Financial Services website daily so we can bring you up to the minute information.

PFL-Waiver    Employee Opt-Out of Paid Family Leave

If an employee does not expect to work long enough for the employer to reach the eligibility requirements, they may opt out of PFL.  Eligibility requires an individual to work 26 consecutive weeks with 20 or more hours per week or 175 days averaging less than 20 hours per week in 52 consecutive weeks. The employer cannot require the employee to complete the waiver form and the employee may revoke at any time. (download here) The employee will be certifying to.

I regularly work 20 hours or more per week, but will not work 26 consecutive weeks (6 months) for this employer or;
I regularly work less than 20 hours per week, but will not work 175 days in 52 consecutive weeks (a year) for this employer.
I understand that this waiver is revoked if my work schedule changes and it is anticipated I will work more than 20 hours per week for 6 months, or will work less than 20 hours per week but at least 175 days in a 52-consecutive week period;
I also understand if this waiver is revoked (either by me or by a change in my work schedule), my employer may take retroactive deductions for the period of time I was covered by this waiver, and this period of time counts towards my eligibility for paid family leave.

PFL-135        Employer Application for Voluntary Coverage (No Employee Contribution)

Employers will certify they are not a covered employer (State, County, Town for example) and elect to voluntarily participate in PFL for a minimum of at least 1 year and will provide 90 days (12 months for public employers) written notice of intent to discontinue for future years. (download here)

PFL-136        Employer Application for Voluntary Coverage (Employee Contribution Required)

Employers will certify they are not a covered employer (State, County, Town for example) and elect to voluntarily participate in PFL for a minimum of at least 1 year and will provide 90 days (12 months for public employers) written notice of intent to discontinue for future years. (download here) Employers will also certify.

If the downloaded forms do not open properly, right click on the downloaded pdf (On your desktop) and select “Open with  – Adobe Acrobat Reader.”

More than ½ of the employees have agreed to contribute to the cost
The agreement was made in writing or by election and date held on
The contribution of each employee (less than or equal to current maximum as set by DFS)
The application must be certified by the employer and employee representative(s)

The final claim forms and employee notice have yet to be released, we will bring those to you as soon as the State has approved and released.

If you should have any questions, please do not hesitate to reach out to your Senior Benefit Consultant or myself directly at 1-800-836-0026 x230 or 585-415-0448 or email at lallen@relphbenefitadvisors.com.

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