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How Do I File a Claim for MA Paid Family & Medical Leave?

What you need when filing a PFML claim in MA, depends on who provides the coverage, and the type of leave being taken.  Speak to your employer to find out who provides your PFML coverage - the State or a private plan.  If your employer has informed you that your Paid Family and Medical Leave Insurance is from ShelterPoint, then you’re in the right spot – we have everything you need to help file your claim below.

Not sure which employers/employees MA PFML applies to?
Go here to read more about coverage requirements under the MA Paid Family & Medical Leave  law. 




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Download MA Paid Family & Medical Leave Claims Forms

 

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BONDING

To Bond with a newly born,
adopted, or fostered child


DOWNLOAD FORM

 

Caring with grandma


CAREGIVER

To care for a family member
with a serious health condition

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Military Caregiver


MILITARY CAREGIVER

To care for a family member
who is a covered service member with an illness or injury related to active service

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MILITARY EXIGENCY

To attend to family matters due to a qualifying military exigency


DOWNLOAD FORM

 

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SELF-CARE
(MEDICAL LEAVE)

Manage and/or recover from your own serious health condition

DOWNLOAD FORM

 



How Do I know Which Form/s I Need to File for My Claim With ShelterPoint?


We’ve put together an easy chart to explain what forms you need and who needs to complete those forms, depending on the type of leave taken.

PFML CLAIM TYPE BONDING FAMILY CAREGIVING MILITARY CAREGIVING QUALIFYING MILITARY EXIGENCY SELF-CARE (MEDICAL)
Claim package to provide to ShelterPoint
Part A: completed by you, the employee
Part B: Completed by your employer. (They must complete their section & return to you within 10 business days of receiving it.)
Bonding Certification form        
Completed by you

HIPAA Authorization Form

(This is provided to the health care provider for their records)		    
Completed by the family member who requires care Completed by Military Service Member (Family Member) who requires care Completed by you
Medical Certification    
Completed by you & the health care provider treating your family member Completed by you & Military Service Member’s (Family Member’s) health care provider Completed by you & your health care provider
Military Exigency Form        
Supporting Documentation      
Ex. Child’s birth certificate Ex. Proof documentation of service / supporting the leave

 

Refer to the checklist enclosed in the respective claim form package for the information needed to complete and submit with the claim.

Please note: Additional requirements may be necessary if leave is taken on a reduced schedule/intermittently. Read more details about reduced schedule/intermittent leave here.

 


More Help with ShelterPoint Claim Forms

  1. Regardless of the qualifying event, you will need to complete and submit the general claim package:

    • Complete Part A (Employee Information) of the MA Paid Family & Medical Leave Claim package. Make a copy for your files.

    • Give it to your employer to complete Part B.  Your employer must complete their section and return it back to you within 10 business days. 

  2. In addition to the completed package, you are responsible for obtaining and submitting the necessary certifications and supporting documents to show the need for your specific leave:


Bonding Leave

For bonding leave, please submit the following:
  • Part A and Part B completed by both you and your employer.
  • Bonding Certification completed by you.
  • Supporting documentation proving the relationship between the you the child, such as their birth certificate.
The MA PFML Bonding Leave Claim Form package has a checklist to help identify exactly what documentation is needed for the specific bonding situation (i.e., birth / adoption / foster).

Caregiver leave

For leave to care for a seriously ill family member, please submit the following:
  • Part A and Part B completed by both you and your employer.
  • HIPAA Authorization for Use & Disclosure of Information completed by the “care recipient”, i.e., the eligible family member of the employee who requires care. (This is for the family member’s health care provider, so the provider can complete the Medical Certification – Family Care Form.) The health care provider should keep a completed copy of this form on file.
  • Medical Certification – Family Care Form completed by you and the health care provider treating your family member.

Military Caregiver Leave

For leave to care for a covered service member with a serious injury or illness related to active service, please submit the following:
  • Part A and Part B completed by both you and your employer.
  • HIPAA Authorization for Use & Disclosure of Information completed by the “care recipient”, i.e., your family member who requires care . (This is for the family member’s health care provider, so the provider can complete the Medical Certification – Military Caregiving Form.) The health care provider should keep a completed copy of this form on file.
  • Medical Certification – Military Caregiving Form completed by you and the health care provider treating the covered service member (who is also an eligible family member).

Qualifying Military Exigencies

For leave as a result of a qualifying military leave event, please submit the following:
  • Part A and Part B completed by both you and your employer.
  • Military Exigency Form completed by you.
  • Supporting documents for the leave, which include proof of document of service (i.e., covered active duty status, impending call/order to covered duty, or Rest and Recuperation document) and the need for leave (such as arranging for child care; arranging for parental care; counselling; spending time with the military member during a rest and recuperation leave or following return from deployment; attending any event sponsored by the military or military service organization; or making arrangements following the death of the military member).

Self-Care (Medical Leave)

  • Part A and Part B completed by both you and your employer.
  • HIPAA Authorization for Use & Disclosure of Information completed by you.
  • Medical Certification – Self Care Form completed by your health care provider.
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PFML Expert Tip: You Must Remember to Notify Your Employer!

You must notify your employer at least 30 days before the start of your leave if it is foreseeable (such as a planned birth or scheduled treatment); otherwise notify your employer as soon as possible.


How to Submit a Claim to ShelterPoint

If your employer provides PFML coverage through ShelterPoint, you can apply for benefits one of the following ways:

    By email: claimforms@shelterpoint.com

    By mail:

ShelterPoint Life Insurance Company
Attn: MA PFML Claims
1225 Franklin Ave, Suite 475
Garden City, NY 11530

    By fax: Fax 516-504-6414

    By web upload: ShelterPoint Online Claim Submission


For the quickest processing time possible, please make sure the fully completed claim package is sent through only one method, and only one time! Submitting through different methods, multiple times or in separate pieces will likely delay the claims processing time. 

  

How MA Paid Family & Medical Leave Can Be Taken



Since leave can be taken continuously, on a reduced leave schedule, or intermittently you’ll need to decide how you will take your leave:


Continuous Leave


Leave from work will be on a continuous basis for days or weeks at a time and you will not be working in-between.


For example, an employee may need several continuous weeks of paid leave to bond with a new baby or to care for a family member who is recovering from surgery.


Reduced Leave Schedule

An arranged consistent, but reduced work schedule with your employer for multiple weeks.

For example, if an employee had a baby and normally works Monday through Friday, they  may arrange with their employer to work Monday through Wednesday, taking Thursday and Friday as bonding days for 12 weeks as part of their PFML benefits. 



Intermittent Leave

Time you take off is episodic. 

For example, the employee may take time off to attend to doctors’ appointments periodically to manage a chronic illness like asthma or epilepsy.

Additional requirements for a reduced or intermittent leave schedule:


  1. In the case of bonding leave, you and your employer must mutually agree to the schedule.

  2. When caring for a family member with a serious health condition, or to care for a family member who is a covered service member with a serious health condition, leave may be taken on an intermittent or reduced leave schedule if the healthcare provider determines it is medically necessary.

  3. For medical leave (self-care), you must advise your employer upon request the reasons why the intermittent/reduced leave schedule is necessary and of the schedule for treatment.  You and your employer must attempt to work out a schedule for leave that meets your needs without unduly disrupting the employer, subject to the approval of the health care provider.

MA Paid Family & Medical Leave Claims FAQs

 

If an employee doesn’t give 30 days’ notice to their employer for a foreseeable leave, can their claim be denied or reduced?

Yes. Since this is required by the law, failure to provide the required notice could have some impact on the actual benefit payment if you aren’t able to provide good cause for the delay. The 30 days’ notice is only applicable for “foreseeable” qualifying events, such as:

  • An expected birth, or placement for adoption or foster care.
  • Planned medical treatment for a serious health condition of a family member.
  • Planned medical treatment for a serious injury or illness of a family member who is also a covered service member.
  • Planned medical treatment for the employee’s own medical care.
In some instances, 30 days’ notice is not possible — as with a medical emergency, sudden changes in circumstances, or premature birth. In these cases, notice must be given to your employer as soon as practicable (possible) given the circumstances of the event.

Is there a waiting period? How does it work?

Yes, there is an unpaid 7-day waiting period (calendar days). However, the waiting period does not apply to bonding leave if immediately preceded by medical leave during pregnancy or recovery from childbirth, or to an extension of benefits.

  • The waiting period days count against the total available period of leave in a benefit year.
  • Sick pay or Paid time off (PTO) can be used during that time to fill in the gap during the waiting period.

How does the waiting period work for leave taken on an intermittent or reduced leave schedule?

The waiting period will be 7 consecutive calendar days starting on the first day leave begins. Any leave days taken during the 7 day unpaid waiting period will be deducted from the maximum allotment of leave available.

What is the “Financial Eligibility Test?”

In order to be eligible to begin receiving benefits, you must meet the “Financial Eligibility Test” at the time of claim with ShelterPoint:

  1. You must have earned (for work in Massachusetts) at least the wage requirement amount set by the MA Department of Unemployment Assistance for unemployment claims. This is updated annually and takes effect the first Sunday in January ($6,300 over last 4 completed calendar quarters as of January 2024,); and

  2. The amount earned must be at least 30 times the weekly MA unemployment insurance benefit amount you would be able to collect under the MA Unemployment Insurance law.

    3. Former employees must have met the above financial eligibility requirement at the time of separation from employment.

Learn More About MA Paid Family & Medical Leave

Overview 


Private Plan Option 


Coverage Requirements 

 

Benefits 


Premium & Contributions 


Claims 


 

Regulatory Updates 


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Massachusetts ABCs of PFML

Our in-depth guide provides everything you need to know about Paid Family & Medical Leave in Massachusetts. Here’s what you’ll find inside this 31-page guide:

  • PFML Basics
  • Benefits
  • Private Plans Explained
  • Contributions
  • Coverage Requirements
  • Eligibility & Claims
  • Compliance
  • Tips from your PFML Experts
  • …and more!

Download your copy now

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The information in this document is based on our knowledge of the MA Paid Family and Medical Leave statute and regulations, and may change as regulations evolve or the MA Department of Family and Medical Leave issues guidance regarding the regulations. 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. The information in this material is not intended as an offer of coverage. It is for illustrative purposes only, providing a general overview of the MA PFML program. It is not a contract. ShelterPoint Life policies are subject to Underwriting approval. Claim payment is not guaranteed; benefit amount depends on wages. All coverage extends up to policy limits. Policies are reviewed annually and may be cancelled for nonpayment. Please refer to the policy for terms under which it may be continued or cancelled, and for policy exclusions and limitations. In the event of conflicting information with the policy, the policy will take precedence over what is shown in this material.

*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, and its wholly-owned subsidiary ShelterPoint Insurance Company, a FL-domiciled carrier, depending on the state.

Available in Massachusetts only. Underwritten by: ShelterPoint Life Insurance Company (principal office in Garden City, NY)
Policy Form# SPL PFMLP 0820 MA

 

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