FAQ – PFL Eligibility

• Who is covered by Paid Family Leave?
• Are self-employed individuals covered by Paid Family Leave?
• Are government employees covered?
• Are employees of small businesses covered by Paid Family Leave insurance?
• May employees receive Paid Family Leave insurance benefits if they work part time?
• Does an employee have to work a minimum number of hours or days before becoming eligible for Paid Family Leave insurance benefits?
• What constitutes a serious health condition for the purposes of Paid Family Leave?
• When must I submit a claim to bond with a new child in order to receive six weeks of benefits?
• Is a claimant eligible for Paid Family Leave insurance benefits if he or she has to provide care for a sick relative (child, spouse, parent, or domestic partner) that is out-of-state or out-of-the-country?
• If an employee accrues Paid Time Off (PTO), rather than specific vacation or sick leave, may an employer require that an employee use up to two weeks of PTO prior to the initial receipt of Paid Family Leave insurance benefits?
• May an employer require employees who have not accumulated two weeks of vacation leave to use his or her earned but unused sick leave instead?

Who is covered by Paid Family Leave?
Employees covered by State Disability Insurance are also covered by Paid Family Leave insurance. If a Voluntary Plan insurer provides a company’s disability insurance coverage in lieu of State Disability Insurance, then it must also provide Paid Family Leave insurance coverage.

Are self-employed individuals covered by Paid Family Leave?
Yes, but only if an employee participates in the State Disability Insurance Elective Coverage Program.

Are government employees covered?
Some government employees, including public school employees, may be eligible for Paid Family Leave insurance benefits if the employee pays into the State Disability Insurance program. Also, if an employee has wages from a private employer during the base period, the employee might qualify even though his or her primary employer is a government entity.

Are employees of small businesses covered by Paid Family Leave insurance?
Yes, if an employee pays into State Disability Insurance, he or she is covered by Paid Family Leave insurance, regardless of the number of employees in the business. An employee may have his or her job protected under other laws, such as the federal Family and Medical Leave Act (FMLA) or the California Family Rights Act (CFRA), but these laws do not apply to everyone who is eligible for Paid Family Leave benefits.

May employees receive Paid Family Leave insurance benefits if they work part time?
If an employee works part time and still suffers a wage loss due to family care leave, he or she may receive benefits provided he or she is otherwise eligible. Paid Family Leave insurance is a wage loss protection program, which means that an employee may be eligible for a portion of the Paid Family Leave insurance benefit if he or she suffers a loss of wages and meets the other Paid Family Leave eligibility requirements.

Does an employee have to work a minimum number of hours or days before becoming eligible for Paid Family Leave insurance benefits?
No, eligibility for Paid Family Leave insurance benefits is based on the earnings shown in an employee’s base period and not a specific number of days or months worked. Wages earned approximately 5 to 18 months before the beginning of a Paid Family Leave insurance claim are included in the base period.

What constitutes a serious health condition for the purposes of Paid Family Leave?
A serious health condition means an illness, injury, impairment, or physical or mental condition of a patient that involves inpatient care in a hospital, hospice, or residential medical care facility. This includes any period of incapacity (e.g., inability to work, attend school, or perform other regular daily activities) or any subsequent treatment in connection with such inpatient care; or continuing treatment by a physician or practitioner. Unless complications arise, cosmetic treatments, the common cold, influenza, earaches, upset stomach, minor ulcers, and headaches other than migraine, are examples of conditions that do not meet the definition of a serious health condition for purposes of Paid Family Leave.

When must I submit a claim to bond with a new child in order to receive six weeks of benefits?
Eligibility for up to six weeks of benefits to bond with a new child expires at the end of the 12-month period that begins on the child’s date of birth, adoption, or foster care placement. Therefore, bonding must be completed prior to the 12-month period ending date and claims must be submitted timely.

Is a claimant eligible for Paid Family Leave insurance benefits if he or she has to provide care for a sick relative (child, spouse, parent, or domestic partner) that is out-of-state or out-of-the-country?
A claim may be submitted for Paid Family Leave benefits to care for a sick parent who is out of the state or out of the country. Benefits may be payable provided the medical certificate is properly completed, establishes a need for care, and a relative (child, spouse, parent, or domestic partner) is otherwise eligible.

If an employee accrues Paid Time Off (PTO), rather than specific vacation or sick leave, may an employer require that an employee use up to two weeks of PTO prior to the initial receipt of Paid Family Leave insurance benefits?
Yes, the law provides the option for employers to require up to two weeks of earned but unused vacation leave. Vacation leave, as defined in Title 22, California Code of Regulations, section 3302-1, includes paid time off if vested under Labor Code section 227.3.

May an employer require employees who have not accumulated two weeks of vacation leave to use his or her earned but unused sick leave instead?
No, the Paid Family Leave law does not authorize employers to require the use of sick leave in lieu of vacation.