MA Paid Family & Medical Leave 2021What Customers Needs to Know

Information is for general informational purposes only and does not constitute legal advice. It does not purport to be complete or to cover every situation. You must consult with your own legal advisors to determine how the Massachusetts Paid Family and Medical Leave law affects you.

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Agenda

1. Comparing state and MetLife Solution options

2. Employer obligations and the timeline for participating in the claims process

3. Best practices for benefit overlap and coordination

4. How to respond to questions from employees, carriers and the state

5. Tools & Resources

6. Q&A

Benefit Plan Design

Here are the MA PFML Benefits

Max 26 weeks per year

Starting January 1, 2021 Starting July 1, 2021

12 weeksChild Bonding

Military Exigency

20 weeksEmployee’s own Serious

Health Condition

26 weeksMilitary Caregiver

12 weeksCare of Family Member with a Serious Health Condition

Foundation for MA PFML

Purpose State Run Program MetLife Solution Options

Paid leave & job protection:• Employee’s serious health

condition• Bond with a new child• Care for a seriously ill family

member• Qualifying military events

Department of Family and Medical Leave (DFML) oversees the state program

• Insured by a carrier• Self-insured

Contribution exemption

Eligibility for MA PFML Benefits

*https://www.mass.gov/info-details/whos-a-covered-individual-under-the-pfml-law

Employees Other Workers

• Full time • Part-time • Seasonal

• Former employees (26 weeks)• Covered contractors (if they’re more than 50%

of your workforce)• Applies to 1099 Contractors who are NOT independent

contractors under MA law*

Covered Entities – Virtually all Employers

Covered Individuals – Financial Eligibility

Contribution Amounts:• Medical Leave: 0.62% (employer pays 60% &

employee pays 40%)• Family Leave: 0.13% (employee pays 100%)• Total: 0.75%

MA PFML is funded by Workers and Employers State Plan Option

Employers with

Life of a Claim

Meet Beverly

Employees must notify employer of leave

Which notice rules apply?• 30 days is the default• As soon as practicable if delay out of Beverly’s control• Mutually agree on leave dates if you can

Beverly tells her Manager that she is pregnant

Best Practices

Add instructions for notice requirements to your normal leave policies and procedures

Add a copy of the state’s Employee Notice to your website

Employees need to apply for MA PFML

Both the state and MetLife Solution will ask similar questions to prove the need for leave

State Plan• Application for state benefits only MetLife Solution

• Coordinate state plans with other benefits• Paid parental leave• FMLA

Separately• File for company benefits• FMLA

Beverly applies for MA PFML benefits

Employers must participate in the claim process

Within 10 business daysEmployers need to reply to state with employment details supporting the claim

Best Practice Recommendations

State Plan:• Update your company’s MA State Contacts for

leave administration• Create a template for repeatable information

• Job Descriptions• Company paid leave benefits

MetLife Solution:• Provide Tip Sheet for company benefits

that may overlap

https://www.mass.gov/forms/leave-administrator-contact-information

Calculating Beverly’s Leave Allotment

Step 1How many PFML days available based on work schedule

Step 2How many PFML days have already been used?

Step 3How many days does the certification allow?

Beverly works 5 days per week

Step 1: 130 days

Step 2: 0 days

Step 3: 30 days for PML + 60 days for PFL

Total: 18 weeks (90 days) for childbirth and bonding

Calculating Beverly’s Benefit Amount

Step 180% of the first 50% of the State’s Average Weekly Wage (“SAWW”) considering wages from all sources

Step 250% of the amount above 50% of SAWW

Step 3Combine Steps 1+2, up to cap

The state has a benefit calculation formula:

Beverly earns $1,000/week

Weekly Benefit: $ 723.17

MA PFML benefit payments may be reduced

The complete l ist can be found on the State’s website

Other Income received may lower the MA PFML benefit:

Government programs (unemployment, workers’ comp)

LTD programs

PFML taken during the benefit year

STD, internal PFML policy, other wages, sometimes

State Plan

The state may verify the employee did not make more than 100% of wages during a claim

https://www.mass.gov/info-details/paid-family-and-medical-leave-pfml-benefit-reductions

Employers can coordinate multiple benefits

Beverly qualifies for her employer’s parental leave policy, which offers 10 weeks of salary continuation: • 6 weeks medical leave and • 4 weeks paid parental leave

How to coordinate Beverly’s benefits:• Weeks 1 – 10: Full wages from employer+ job protection from MA and FMLA• Weeks 11 – 18: $723.17/week; job protected

Accruedleaves vs.

Non-accrued leaves Beverly’s employer:• Qualifies for MA PFML Reimbursement

• Will run FMLA concurrently

What happens once a claim is approved

Beverly only has 1 waiting periodBeverly returns to work as expected after 18 consecutive weeks.

Extension of Benefits: Requires new application

Applied to the first 7 calendar days of the leave (2 exceptions)

Waiting Period

Can be part of the Return to Work plan

Fit for Duty

State will ask employer for additional approval details

State to Employer

Employer must respond within 10 business days

Employer to State

Own or family member’s serious health condition: only when medically necessary

• Bonding: only if the employer and employee mutually agree

• Qualifying Exigency: when requested

Medical

Family Leave

When intermittent and reduced schedule leaves may apply

Former employees may also take MA PFML intermittently or on a reduced schedule

Add your minimum intermittent leave increment allowed for each leave type to your company benefit site and handbook

Best Practice

Employers can manage absences

Intermittent and reduced leave schedules should be documented so you can manage absences

An employee who does not follow the schedule/fails to work during times agreedto may be subject to employer discipline

Employer can contact the plan administrator if the employee fails to adhere to the agreed up on intermittent/reduced leave schedule

This would not be considered retaliatory per the regulations

What is the Appeals Process?

* Assumes MetLife Solution follows the same timeframes as the state

Individuals and employers notified

Individual can appeal

Decision issued

District Court complaint

Decision 10 Days 30 Days 30 Days

Individuals and employers notified

Decision

Individual can appeal

10 Days

Decision issued

30 Days

State Plan

MetLife Solution*1st Round of Appeals

If needed, 2nd round appeal with state

Program at a GlanceIn Summary

MA PFML benefits

Weekly benefit payment is a percent of wages up to a maximum12 Weeks• Child Bonding• Military Exigency• Care of Family (7/1/2021)

20 WeeksEmployee’s own Serious Health Condition

26 Weeks• Military Caregiver• Total Combined Family

& Medical

Benefit Calculation:

+80% benefit on 50% of the state average weekly wage 50% on the balance up to cap

$850 maximum weekly cap for 2021

Claim administration timeline

Decision Benefit PaymentsEmployer

Response SentApply for Benefits

Send Employer Verification

Employee State/Administrator Employer State/Administrator

30-60 days in advance

Within 5 days of

receiving

Within 10 days of receiving request from Administrator

Within 14 days of receiving all materials

Within 14 days of approval or first

absence date

• If delay is out of the employee’s control, notice as soon as practicable

• Filing on behalf of employee may be allowed when approved by DFML

• MetLife Solution has flexibility for obtaining information

• Employer has option to weigh in on worker’s request

• May set up reimbursement if applicable

• Employee and employer be notified of the decision

• If denied an appeal process is available

• MetLife Solution will have appeals at both plan level and state level

• If employee is overpaid, they will have to repay the DFML within 30 days

• Employers may be required to send monthly reports to assist state in payment tracking

Checklist: Info the state may request from employers

State Plan: Within 10 business days of receiving a request for information, employers needto confirm the following employment information with the state so they can adjudicate a claim:

Last 12 months’ wages and/or earnings information

Job description

Work schedule (full time or part-time and weekly hours worked)

Prior requests/approvals for a qualifying reason

The amount of paid leave already taken

Description of the employer’s paid leave policies and if the employee used/plans to use leave during the PFML period

Whether the employee applied for FMLA or other concurrent leave and whether the employer approved the application

Other wage replacement benefits the employee will receive and any other relevant information, such as evidence of fraud

Potential consequence for not responding: Per the regulations, the state may deem the application complete, which triggers the state’s deadline to determine the claim.

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Other Leaves that may overlap with MA PFML

Benefit Paid/Unpaid Offset MA PFMLImpact to Employer

Sponsored Plan

Unpaid/Job protected or Paid/Job protected

Will subtract either time or paid benefits from MA PFML entitlement

Benefits can be offset or reimbursed due to overlapping benefits

Federal FMLA –Medical Leave, Child Bonding, Military Unpaid Yes N/A

Federal FMLA –Care Family Member –Child, Spouse, Parent Unpaid Yes N/A

Federal FMLA –Care Family Member – other family Not applicable No N/A

Company Sponsored Paid Maternity/Bonding/Salary Continuation (non accrued leaves)

Paid Maybe MA PFML Reimbursement possible

Company’s Short-Term Disability Paid Maybe Company STD offset possible

Company PTO for a MA PFML qualifying reason Paid Yes• No: Accrued leave paid 100%;

Job protection only• Maybe: Top up supplement

MA State Sick Leave/Employer Sick Leave Paid Maybe No (accrued leave pays 100%)Job protection only

Helpful Links:• MetLife’s PFML Microsite• Massachusetts State PFML Website

Best Practices:• Research MA PFML using trusted sources • Beware of scammers as on-line claim process is available for claim details

Tools & Resources

www.metlife.com/PFML

https://www.mass.gov/orgs/department-of-family-and-medical-leave

MA Paid Family & Medical Leave 2021AgendaSlide Number 3Here are the MA PFML BenefitsFoundation for MA PFMLEligibility for MA PFML BenefitsMA PFML is funded by Workers and EmployersSlide Number 8Slide Number 9Employees must notify employer of leaveEmployees need to apply for MA PFMLEmployers must participate in the claim processCalculating Beverly’s Leave AllotmentCalculating Beverly’s Benefit AmountMA PFML benefit payments may be reduced Employers can coordinate multiple benefitsWhat happens once a claim is approvedWhen intermittent and reduced schedule leaves may applyEmployers can manage absencesWhat is the Appeals Process?�Slide Number 21MA PFML benefitsClaim administration timelineChecklist: Info the state may request from employersOther Leaves that may overlap with MA PFMLTools & ResourcesSlide Number 27