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Think of Paid Family & Medical Leave (PFML) in Delaware as a 2-lane highway: the State Plan and the Private Plan. The destination is the same no matter which route an employer chooses, but depending upon their circumstances, employers might find that one or the other is an easier trip.
Employers who haven’t decided which path to choose will need to do so soon. When considering the Private Plan route, it’s important to stay on top of state-mandated deadlines. The Private Plan application window is similar to an open enrollment window. And it’s open NOW: October 1 through December 1, 2025. This is the last opportunity for a Private Plan to go into effect at the same time when benefits launch on January 1, 2026.
When the window closes, employers who are not enrolled in a Private Plan will kick off their Paid Family & Medical Leave journey in the State Plan – along with obligations specific to the State Plan. Learn more about these Employer Responsibilities here.
This roadmap breaks down two different paths employers will take to manage claims, depending on whether they choose to leverage the State Plan or have chosen to work with a carrier for a fully insured Private Plan, like ShelterPoint’s*:
Benefits, and therefore Claims, Begin
Employees can start filing claims in January 2026. The required steps vary depending on whether the employer chooses the State Plan or a fully insured Private Plan. We recently broke down the differences between these options in our Delaware PFML Employer Webinar – check out the recording here if you missed it.
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State Plan Route
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Fully Insured Private Plan Route
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Employee files a claim in the Delaware Department of Labor’s online system.
That application is automatically shared with the employer, who must reasonably assist with information and certifications in a timely manner.
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Employee files with the employer's insurance carrier or third-party agent under an approved policy.
Note that employers using a Private Plan must still provide wage and eligibility information and must continue quarterly reporting to the Division of Paid Leave.
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Adjudication Checkpoint
Once an employee has submitted a claim and all the proper information has been filed, a decision is needed.
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State Plan Route
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Private Plan Route
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The employer adjudicates the claim using a “reasonable person” standard.
Once the application is complete and the employer has been notified, the employer will have 5 business days to approve or deny the claim and upload any claim documentation within 3 business days of that decision.
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Typically, the carrier or third-party administrator adjudicates the claim under a plan that offers rights and protections at least equal to the State Plan.
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Paying Benefits & Payroll Coordination
Once a claim has been approved, the employee can begin to receive benefits.
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State Plan Route
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Fully Insured Private Plan Route
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The Delaware Paid Leave State Plan pays approved claims. Employees can expect the first payment within 30 days, and subsequent payments will be made biweekly.
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For employers using a Private Plan provided by a carrier, the carrier pays benefits per the approved policy.
If an employer is using a self-insured plan, payments are made from a prefunded, dedicated claims account that’s backed by a surety bond equal to one year of contributions.
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Detours & Disputes
Even with preparation and planning, obstacles can appear on the road ahead, but there are resources available to help. Employees can seek appeals to handle claim decision disputes.
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State Plan Route
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Fully Insured Private Plan Route
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Employee can ask the state to review an employer’s decision within 60 days.
The Delaware Division of Paid Leave will issue a determination within 10 business days.
Any further appeals will go to the Delaware PFML Appeal Board.
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Employee requests reconsideration with the carrier (within 10 days of an adverse decision).
If upheld, they may appeal to the Delaware PFML Appeal Board.
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The Road Ahead: Ongoing Reporting and Benefits Protections
Whether employers choose to stick with the State Plan or opt for a Private Plan, they will have to submit reports and remain compliant with the state’s requirements:
- Quarterly Reports: Employers must submit wage and hour reports via LaborFirst every quarter, regardless of plan type. Employers with Private Plans are not obligated to file quarterly wage reports before the end of Q1 2026.
- Continue Health Coverage: Employees must have access to continued coverage during leave, with employees still responsible for their usual share of premiums.
- Job Protection: Employees must be reinstated to their original job or an equivalent one upon return from leave.
- Notice: Employers are required to provide program notices to employees as specified under the regulations.
Helping Businesses Navigate PFML
With some planning, employers can confidently navigate their Delaware PFML obligations—ensuring both compliance and a smooth experience for employees. Employers can choose the State Plan if they’re comfortable adjudicating claims in-house while the state handles payments.
Employers may choose a Private Plan if they prefer having a carrier or third-party administrator run adjudication and payments. An employer looking to take the Private Plan route when benefits start on January 1, 2026, will need to file their exemption from the State Plan during the Private Plan application window, which is open from October 1 to December 1 in 2025. If you are considering a fully insured Private Plan from ShelterPoint, keep in mind that our quote deadline is November 12 to allow time for quoting, issuing your policy, and for applying to the State by December 1.
Choosing a Delaware Private PFML Plan through ShelterPoint can make the journey easier for employers.
- We handle the claims directly—your employees won’t need to navigate a state portal or file claims with the Delaware DOL.
- Our team guides claimants and employers through every step, ensuring complete documentation and timely processing.
- Streamlined service from a trusted PFML provider with decades of experience in paid leave.
- Direct communication and support—employers and employees alike can speak with knowledgeable claims reps for help, not an automated system.
PFML… That’s just our thing.
We simplify compliance and make it easier to manage leave benefits. Stay informed about PFML in Delaware by subscribing to updates. You can also check out the recording of our Delaware PFML Employer Webinar.
*The ShelterPoint family of companies operates under the “ShelterPoint” name strictly as a marketing name, and no legal significance is expressed or implied. The ShelterPoint family of companies consists of ShelterPoint Life Insurance Company, a NY-domiciled carrier (principal office in Garden City, NY), and its wholly owned subsidiary ShelterPoint Insurance Company, a FL-domiciled carrier, depending on the state. ShelterPoint is a registered service mark.
This material is for informational purposes only and is not intended to provide legal counsel. Please consult with an appropriate professional for legal and compliance advice. Any program information is based on our knowledge and understanding of Delaware’s applicable laws and regulations as of the publication date and may change as laws or regulations evolve, or as the Delaware Department of Labor issues updated guidance. Further, this material is for illustrative purposes only, providing a general overview of the services described. It is not a contract nor intended as an offer of coverage.
Policies are subject to Underwriting approval. Policies are reviewed annually and may be cancelled for nonpayment. All coverage extends to limits reflected in the policy. Please refer to the policy for coverage details pursuant to its governing law, including a complete listing of covered services, provisions, conditions, exclusions, limitations, and terms under which the policy may be continued or cancelled. In the event of conflicting information with the policy and its governing Law, the policy and governing Law will take precedence over what is shown in this material. Claim payment is not guaranteed; benefit amount depends on wages.
The provisions of the Delaware Family and Medical Leave Insurance Program, 19 Del. C. § 3701 et seq., and its implementing regulations, 19 Del. Admin. Code § 1401 et. seq. govern this Private Plan and its interpretation and administration. Available in DE only.
Underwritten by: ShelterPoint Life Insurance Company (principal office in Garden City, NY) in: DE (form# SPL PFMLP 0624 DE).