Connecticut PFML: Benefits

Covered family members include:

• spouse
• sibling
• child
• grandparent
• grandchild
• parent
• an individual related to the employee by blood or affinity, whose close association with the employee shows to be the equivalent of those family relationships.

No, there is no waiting period. An eligible employee may receive benefits from the first day of leave.

A serious health condition is an illness, injury, impairment, or physical or mental condition that involves (A) Inpatient Care in a hospital, hospice, nursing home or residential medical care facility; or (B) Continuing Treatment, including outpatient treatment, by a Health Care Provider. A person has a serious health condition if they have one or more of the following conditions listed below.

1. Inpatient care: an overnight stay in a hospital, hospice, nursing home, or residential medical care facility. This may also include any subsequent treatment in connection with the inpatient care. Leave is covered even if the surgery is elective but requires an overnight stay.
   
   
2. Continuing treatment by a Health Care Provider (one or more of the following)
   1. Incapacity⁵ and treatment: (including pregnancy) A period of incapacity of more than 3 consecutive calendar days, and any subsequent treatment or period of incapacity relating to the same condition, but it must also involve:
      1. Two or more in-person visits to a health care provider or by a nurse or physician’s assistant under direct supervision of a health care provider, or by a provider of health care services (e.g. physical therapist) under orders of, or on referral by, a health care provider for treatment within 30 days of the first day of incapacity, unless extenuating circumstances exist.
      2. At least one in-person visit to a health care provider for treatment within seven days of the first day of incapacity, which results in a regimen of continuing treatment under the supervision of the health care provider.
         
         
   2. Chronic conditions requiring treatments: any period of incapacity due to or treatment for a chronic serious health condition (such as diabetes, epilepsy, asthma) which
      1. Requires periodic visits for treatment by a healthcare provider at least twice a year; and
      2. Continues over an extended period of time (including recurring episodes of a single underlying condition); and
      3. May cause episodic incapacity rather than a continuing period of incapacity.
         
         
   3. Any period of incapacity due to pregnancy, or for prenatal care.
      
      
   4. Permanent/long-term conditions: A period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective, but which requires the continuing supervision of a Health Care Provider. Examples include Alzheimer’s disease; terminal states of cancer; severe stroke.
      
      
   5. Multiple treatments for non-chronic conditions (such as chemotherapy; physical therapy):
      
      1. Restorative surgery after an accident or other injury; or
      2. A condition that would likely result in a period of incapacity of more than 3 consecutive full calendar days if the employee or employee’s family member did not receive treatment .

There are many treatments or illnesses that are NOT considered a “serious health condition” under CT PFML law unless there are complications that require inpatient care or continuing treatment. Some examples that do not meet the definition of serious health condition include:

• Routine examinations
• Activities that can be and are initiated without a visit to a health care provider is not by itself sufficient for leave, such as taking over-the-counter medications (e.g., aspirin, antihistamines, or salves), bed-rest, drinking fluids, exercise, etc.
• The common cold, the flu, earaches, upset stomach, minor ulcers, headaches other than migraines, routine dental or orthodontia problems, periodontal disease, etc. (unless complications arise).
• Cosmetic treatments, such as most treatments for acne or plastic surgery, unless inpatient hospital care is required or unless complications develop.

Note: There may be other situations like restorative dental or plastic surgery which may be covered if there is a serious health condition such as cancerous growths as part of the medical condition. Certain mental illnesses may also be covered. Leave may be taken only for certain substance abuse treatments and not for absences caused by an employee’s use of the substance.