Paid Family Leave: Information for Health Care Providers

TOP Paid Family Leave: Information for Health Care Providers
Impact on Patient Health
WYSIWYG

Paid Family Leave can provide a number of health benefits for employees and their families. For example, studies have shown that:

    • new mothers who take paid leave have fewer postpartum depression symptoms and higher breastfeeding rates and longer duration;
    • parents are less stressed and have stronger parent-child bonding;
    • infants have fewer infections and are generally healthier; and
    • hospitalized patients who are cared for by family members have shorter hospital stays and improved health outcomes.    
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Your Role
Your Role
WYSIWYG

Health care providers can play a critical role in:

    • educating patients and their families about New York State Paid Family Leave;
    • determining if a patient with a serious health condition is in need of family care and helping them receive the support they need;
    • providing the required certification or documentation to patients and family members who request Paid Family Leave for either bonding with a new child or caring for a family member with a serious health condition.

The following Licensed Health Care Providers may complete necessary documentation for Paid Family Leave within their scope of practice:

    • Physician
    • Physician Assistant
    • Chiropractor
    • Dentist
    • Physical Therapist
    • Nurse Practitioner
    • Registered Professional Nurse
    • Podiatrist
    • Optometrist
    • Psychologist
    • Clinical Social Worker
    • Occupational Therapist
    • Midwife
    • Mental Health Practitioner
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Bonding Leave
Bonding Leave
WYSIWYG

Patients will be able to request Paid Family Leave and receive job-protected, paid time off to bond with a newly born, adopted, or fostered child. Paid Family Leave only begins after birth and is not available to patients for prenatal conditions. A parent may take Paid Family Leave during the first 12 months following the birth, adoption, or foster placement of a child.

Certification for Birth

A parent whose name is listed on a child’s birth certificate can submit that birth certificate as documentation for bonding leave. However, since birth certificates typically are not available for some time after a child’s birth, a letter from a health care provider documenting qualifying information may be needed. 

The letter, provided by the health care provider, certifies the birth of the newborn and must include:

            • the mother’s name;
            • the actual or expected date of the child’s birth;
            • the physician/provider’s name, address, phone number, and medical credentials (information on the letterhead is often sufficient)

An individual who is not the birth mother must submit documentation establishing their legal role as the child’s parent, and demonstrating their relationship to the birth mother. Acceptable forms of documentation include:

            • a birth certificate, court order of filiation, voluntary acknowledgment of paternity naming that parent, or a copy of documentation of pregnancy or birth from the health care provider that includes the mother’s name and child’s due date or birth date; and
            • a second document verifying the parent’s relationship with the birth mother or child (i.e., marriage certificate, civil union, or domestic partnership documents)

Leave Process for Bonding

Below is an example of the process a patient will go through to take Paid Family Leave for bonding:

Newborn

1.     Patient

      • The birth mother (patient) may request a letter from her health care provider in order to submit a request for Paid Family Leave

2.     Health Care Provider

      • Provides a letter to the birth mother (patient) – (see above for information on what needs to be included in the letter) 

3.     Patient

      • The birth mother (patient) submits the letter  along with a completed Request for Paid Family Leave (Form PFL-1) and Bonding Certification Form (PFL-2) to her employer’s insurance carrier

4.     Insurance Carrier or Self-Insured Employer

      • The insurance carrier must pay or deny the request within 18 calendar days of receiving the completed forms

Adoptive Child: No action required from health care provider 

In adoptions, a court document finalizing adoption must be provided, or a document showing that the adoption process is underway is required if leave is pre-adoption. If the second parent is not named in the court document, a second document must be filed verifying the relationship to the parent named in the adoption.

Foster Child: No action required from health care provider

For foster care, a letter of placement issued by a county or city department of social services or a local voluntary agency is required. If a second parent is not named in documentation, a copy of the letter, plus a second document verifying the relation to the parent named in the foster care placement is needed.

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Family Care
Family Care
WYSIWYG

Family members of your patients (care recipients) will be able to request Paid Family Leave and receive job protected, paid time off to care for their loved one with a serious health condition.

Qualifying Family Members

Qualifying relatives with a serious health condition include the family member’s:

      • spouse
      • domestic partner
      • child
      • stepchild
      • parent
      • stepparent
      • parent-in-law
      • grandparent
      • grandchild

Leave process for Family Care

Below outlines the process for family members who would like to request family care for patients with a serious health condition:

1.     Patient (Care Recipient)

      • Completes a ‘Release of Personal Health Information’ (Form PFL-3) and submits it to their health care provider
      • Submits ‘Certification for Care of Family Member with Serious Health Condition” (Form PFL-4) to their health care provider

2.     Health Care Provider

      • Receives the 'Release of Personal Health Information' (Form PFL-3) from the patient and keeps a copy for their records
      • Completes their portion of the 'Certification for Care of Family Member with Serious Health Condition' (Form PFL-4) and returns it to the patient or the patient’s designee

3.     Patient (Care Recipient)

      • Receives the completed 'Certification for Care of Family Member with Serious Health Condition' (Form PFL-4) from their health care provider
      • Gives the completed 'Certification for Care of Family Member with Serious Health Condition' (Form PFL-4) to their family member (employee) requesting leave

4.     Family Member (Employee)

      • Receives the completed 'Certification for Care of Family Member with Serious Health Condition' (Form PFL-4)
      • Sends completed forms and supporting documentation to their employer’s insurance carrier

Responsibilities in Family Care Certification

Health care providers protect the well-being of the patients they serve. Health care providers may refuse to supply a certification for family care when the family member (employee) requesting leave is the perpetrator of domestic violence or child abuse against the patient (care recipient).  

What is a Serious Health Condition?

A serious health condition is defined as an illness, injury, impairment, physical or mental condition requiring:

      • inpatient care in a hospital, hospice, or inpatient/outpatient residential health facility; or
      • continuing treatment or supervision by a health care provider.

 

Continuing treatment or supervision means one or more of the following:

      • A period of incapacity related to restorative surgery or treatment for a condition resulting in a period of incapacitation lasting more than three days in the absence of medical intervention

      • A chronic, serious physical, or mental health condition that causes a period of incapacity

      • long-term or permanent incapacitating condition for which treatment may not be effective

      • An incapacitating condition lasting more than three days

Note: This is the same standard for leave under the FMLA.

Cosmetic treatments (such as plastic surgery) are not eligible conditions unless inpatient hospital care is required or complications develop. Ordinarily, unless complications arise, the common cold, the flu, ear aches, upset stomach, minor ulcers, headaches other than migraine, routine dental or orthodontia problems, periodontal disease, etc., are examples of conditions that do not meet the definition of a serious health condition and would not qualify for Paid Family Leave.

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Paid Family Leave and Other Benefits
Paid Family Leave and Other Benefits
WYSIWYG

How is Paid Family Leave (PFL) and the federal Family Medical Leave Act (FMLA) different?

 

PFL

FMLA

Benefits

PAID

UNPAID

Coverage
  • All private employers
  • Public employers may opt in
  • One or more employees in any calendar year

 

  • Public and private employers
  • 50 or more employees in a 75-mile radius

 

Eligibility

  • After 26 consecutive weeks of employment if regularly working 20 or more hours per week
  • After 175 days worked if regularly working less than 20 hours per week

 

  • 12 months of employment
  • 1,250 hours of work in the 12-month period preceding leave

 

Reason for Leave

  • Employees cannot use for own serious health condition
  • Can be used to care for a child of any age

 

  • Employee can use for own serious health condition
  • Can only be used to care for a child if the child is under 18 years old, or “incapable of self-care because of a mental or physical disability”

 

 

Length of Leave

  • Only in full-day increments
  • Hourly basis

Paid Time Off

  • Employers cannot require employees use paid time off while on PFL
  • Employers can compel an employee to use paid time off while on FMLA

How does Paid Family Leave work with other benefits and leave policies?

  • Family Medical Leave Act: If an employee has an event that qualifies for leave under both FMLA and Paid Family Leave and their employer is covered under both laws, the employee’s leave should run concurrently.
    • For example, in 2018, if the employee is eligible to take 12 weeks of leave to care for a family member with a serious health condition, the first eight weeks would be classified as both Paid Family Leave and FMLA, and the remaining four weeks would be classified as FMLA leave.
    • In order for the two types of leaves to run together, the employer must notify the employee that their leave qualifies for both FMLA and Paid Family Leave and that it will be designated as such.
    • If an employee has a qualifying event for FMLA and a different qualifying event for Paid Family Leave (for example, caring for their own medical condition using time with FMLA and bonding with a new child using Paid Family Leave), they may take these leaves at different times.
  • Short-term Disability: An employee cannot take short-term disability and Paid Family Leave at the same time. However, if they qualify for short-term disability (for example, after giving birth), they may take short-term disability and then Paid Family Leave. An employee cannot take more than 26 weeks of combined short-term disability and Paid Family Leave in a 52-week period.
  • Workers’ Compensation: If an employee is collecting workers’ compensation for a total disability, they cannot take Paid Family Leave. If they are on a reduced earnings schedule, they may still be eligible for Paid Family Leave.
  • Maternity Leave/Paternity Leave: Employees should check with their employer on how Paid Family Leave works with their employer’s leave policies.

If an employee took parental leave or FMLA in 2017, are they still eligible for bonding leave in 2018 under Paid Family Leave?
Yes, an employee would be eligible to take Paid Family Leave in 2018 to bond with their child as long as the child was born, adopted, or fostered within the last 12 months. Any leave the employee took in 2017 (paid or unpaid, whether maternity/paternity leave through their employer, FMLA or short-term disability) does not affect their Paid Family Leave eligibility for 2018. For example, if the employee gave birth to a child in May 2017, they can take up to eight weeks of Paid Family Leave before their child’s first birthday, regardless of any time off they took in 2017. If they’ve taken short-term disability, it’s important to note that they cannot exceed 26 weeks combined short-term disability and Paid Family Leave in a 52-week period. 

 

If an employee completed paperwork for short-term disability, do they still need to do it for Paid Family Leave?
If the employee is requesting short-term disability and Paid Family Leave, they have to complete separate requests for each. These are separate benefits, which are not taken at the same time, and which require separate documentation from the employee and their employer.

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Educating Your Patients
Educating Your Patients
WYSIWYG

To help raise awareness on Paid Family Leave, health care providers are encouraged to:

  • Speak with patients and their families about Paid Family Leave
  • Display posters and other materials in office settings
  • Direct patients and their families to the Paid Family Leave website at ny.gov/PaidFamilyLeave or the Helpline: (844) 337-6303 for more information
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Other Resources