Short-Term Disability (STD) and Paid Family Leave (PFL) FAQs for employees who do not pay into CA SDI

General

What is the difference between a Disability claim and a Paid Family Leave (PFL) claim?

A Disability claim protects a portion of your income if you become sick or injured and are unable to work.

A Paid Family Leave (PFL) claim benefit provides a portion of your salary when you need to take time off work to care for a seriously ill family member, bond with a new child or attend to family matters if a family member is called to active military duty.

Who is qualified for the Paid Family Leave (PFL)?

Paid Family Leave (PFL) is for employees who do NOT pay into CA SDI and who elect the County’s Short-Term Disability (STD) plans with maximum durations of 3-weeks, 7-weeks, or 12-weeks.

Employees who pay into the CA SDI plan are NOT eligible for the County’s PFL program.

What is a Paid Family Leave (PFL) Qualifying Event?

A Qualifying Event must occur on or after the enrollment effective date*, and includes:

  • Birth, adoption or foster placement of a new child
  • Leave to care for a seriously ill family member
  • Leave due to a family member’s military deployment, such as:
    • Providing or arranging for care during the deployment
    • Assisting in making legal or financial arrangements during the deployment
    • Attending counseling
    • Assisting the military member during rest and recuperation leave
    • Attending military sponsored events or ceremonies
    • Representing the military member at federal, state, or local events
    • Addressing issues due to the military member’s death

*Enrollment effective date:

  • If you enroll during Open Enrollment, the effective date will be January 1st of the following year.
  • If enrolling as a new hire, the effective date is the first of the month following the new hire enrollment. Our New Hire Coordinator will confirm your enrollment date via email.

If I enroll in Short-Term Disability (STD) plan, am I required to enroll in the Paid Family Leave (PFL) plan?

Yes.  Employees enrolled in a 3 week, 7 week or 12 week Short-Term Disability (STD) plan automatically include the Paid Family Leave (PFL) benefit. They cannot be elected separately.

Can I purchase Paid Family Leave (PFL) only and not the disability leave?

The Short-Term Disability (STD) plans are bundled with PFL and cannot be elected separately.

If I receive County paid Long-Term Disability (LTD), which Short-Term Disability (STD) option should I choose?

County paid Long-Term Disability (LTD) plans have a 30-, 60- or 90-day elimination period.  Voluntary LTD plans have an 180-day elimination period.

Please check the Summary of Benefits Flex Credits to find the waiting period for your LTD plan.

To choose a plan that best aligns with the start date of your LTD plan, it is best to choose a plan that does not overlap with the LTD benefit.  For employees with a:

  • 30-day waiting period, the 3-week enrollment would not overlap.
  • 60-day waiting period the 3- week or 7-week enrollment would not overlap.
  • 90-day or 180-day waiting period, the 3-week, 7-week or 12-week enrollment would not overlap with the LTD benefit.

If my County paid Long-Term Disability (LTD) begins at 60 days, is there any additional benefit to enrolling in the 12 weeks Short-Term Disability (STD) plan)

No. LTD pays a higher benefit and STD and LTD run concurrently. Your maximum payment may not exceed 66 2/3% from both benefits or any other sources. We recommend employees elect the STD plan that correlates with their LTD waiting period. Please refer to the County-Paid Long-Term Disability Benefits Summary to see plan details

I have purchased the Short-Term Disability (STD) plan that is a supplement to State Disability Insurance (SDI), and I pay into SDI through the state of California. Does the Paid Family Leave (PFL) enhancement apply to my STD plan?

No.  If you pay into SDI through the state, you will have access to PFL benefit through the state program.

Only those employees who are ineligible for the CA/SDI benefit are eligible for the County’s STD/PFL coverage.

What family members are covered under Paid Family Leave (PFL)?

Child, Parent, Parent-in-law, Grandparent, Grandchild, Sibling, Spouse or Registered Domestic Partner.  (Note that Parents-in-law, Grandparents and Grandchildren are not eligible family members for military exigency.)

Do the number of weeks of Paid Family Leave (PFL) match the number of disability weeks I purchased? For example, if I purchased 3 weeks of disability leave, am I only eligible for 3 weeks of PFL?

No. The duration of your Short-Term Disability (STD) benefit is based on your disability and the maximum duration of the plan you elected.

You’re entitled to receive up to eight weeks of PFL benefits regardless of your STD plan election.

What is the waiting period to use the Paid Family Leave (PFL) benefit and how is it different than the Short-Term Disability (STD) waiting period?

There is no waiting/elimination period to use Paid Family Leave (PFL) benefit.  The Short-Term Disability (STD) plan has a seven-day elimination period.

How often may I use my Paid Family Leave (PFL) benefit?

The PFL benefit is 8 weeks per 12 month rolling calendar year regardless of the number of events.

I need to use Paid Family Leave (PFL) to care for my parent in one month, but my spouse requires surgery the next month, and I will also need PFL to care for them.  Is that allowed? 

Yes.  The PFL benefit is 8 weeks maximum per 12 month rolling calendar year regardless of the number of events.

Can I cancel my enrollment in Short-Term Disability (STD) anytime or the year?

No.  This plan does not allow changes outside of our annual open enrollment.

Are there any pre-existing condition exclusions?

Pre-existing condition exclusions do not apply to Paid Family Leave (PFL); however, they will continue to apply to the Short-Term Disability (STD) plans during the first 12 months you’re covered.

 

Vacation Time, Sick Leave and Benefit Calculations

How are Paid Family Leave (PFL) benefits calculated?

PFL benefits are payable at 60% of your average weekly salary and are calculated similarly to California’s EDD. Please use this calculator to estimate your benefit:  Lincoln Benefit Calculator (must be on County network to access)

Are there any benefit reductions or offsets to Short-Term Disability (STD) plan?

STD will coordinate with your income, sick pay or any catastrophic donations received during your disability.  You cannot receive more than 100% of your pre-disability average weekly salary.

Your benefits may be reduced if you are eligible to receive a retirement plan distribution; Social Security; any form of employment salary; or Workers’ Compensation.  Work related disabilities are excluded from Lincoln’s STD plan.

If I’m on Paid Family Leave (PFL), can I supplement the payment I receive with sick and/or vacation?

Yes. However, any combination of income or benefits may not exceed 100% of pre-disability earnings.

If I have an approved Paid Family Leave (PFL) claim, can I use my sick and/or vacation to receive over 100% of my salary?

No. Any combination of income or benefits may not exceed 100% of pre- disability earnings.

Does either sick or vacation leave need to be exhausted before benefits are paid?

No. Neither sick nor vacation time need to be exhausted before STD or PFL benefits are paid; however, paid sick/vacation time plus leave benefits may not exceed 100% of pre-disability earnings. Central Payroll Administration will ensure any leave hours in excess of 100% paid to the employee’s paycheck will be reconciled.

Does the Paid Family Leave (PFL) calculation affect FMLA/CFRA time?

No. PFL is considered income replacement. FMLA/CFRA provide job and benefits protection for eligible employees.

How do I know how much sick/vacation time to use while on intermittent FMLA/CFRA leave?

Before going out on FMLA/CFRA, you should work with your Department Human Resources Officer (DHRO) to determine how you wish to use your accruals during your leave.

 

Bonding Scenarios

I am currently pregnant, and my delivery date is shortly after the first of the year, am I eligible to use the Paid Family Leave (PFL) benefit? If so, when can I begin to use it?

Answer A: Yes. If you remain enrolled, the PFL benefit is payable for qualifying events that occur on or after your enrollment effective date. In this scenario, the actual delivery date is the “qualifying event”. Your PFL benefit may begin after your STD benefit ends – you may take your time in one continuous leave or intermittently (in one day increments) within the first 12 months after your child’s birth.

Answer B: Yes. If you are not currently enrolled but choose to elect the plan during Open Enrollment, the PFL benefit is payable for qualifying events that occur on or after 01/01 of the upcoming year. In this scenario, the actual delivery date is the “qualifying event”. Your PFL benefit  may begin after any disability benefit ends – you may take your time in one continuous leave or intermittently (in one day increments) within the first 12 months after your child’s birth. 

Note: Your STD benefit would not be payable in Answer B’s scenario due to the pre-existing exclusion.

My spouse is pregnant and due to give birth in January. If I enroll in Short-Term Disability (STD) during Open Enrollment, am I eligible to use Paid Family Leave (PFL) for the purpose of bonding time with my new baby?

Yes. There is no waiting period for PFL. The PFL benefit is payable for qualifying events that occur on or after the enrollment effective date. In this scenario, the actual delivery date is the “qualifying event” and will occur after the January 1st enrollment effective date.

I’m expecting to have a foster child placed with me after the new year.  If I enroll in Short-Term Disability (STD) during Open Enrollment, am I eligible to use Paid Family Leave (PFL) for bonding?

Yes. In this scenario, the actual placement date is the “qualifying event” and there is no waiting period for PFL.

 

Pregnancy Related Questions

I am currently out on Pregnancy Disability Leave (PDL) and plan on enrolling in Short-Term Disability (STD) during Open Enrollment.  Will I be eligible for Paid Family Leave (PFL)?

In this scenario, no, because your enrollment would be after the event effective date, which would be January 1st of the upcoming year.  For this pregnancy event, you would not be eligible for the STD or the PFL benefits.  However, you would be able to use the plan for another type of disability or PFL not related to this pregnancy.

I’m already pregnant so I understand I would not qualify for the disability benefit due to being pregnant before choosing the plan during Open Enrollment.  Would I qualify for the Paid Family Leave (PFL) benefit with a January 19th due date?

Yes. The delivery date is the event date and you would be eligible for PFL if delivery occurs January 1st or later.

Do I have to continue enrollment in the Short-Term Disability (STD) plan to get the Paid Family Leave (PFL) benefit?

Yes. You must stay enrolled in STD to receive the PFL benefit. PFL pays for up to 8 weeks per year. The plan stays active throughout the entire year and cannot be dropped outside of Open Enrollment.

If I am enrolled in the 3-week Short-Term Disability (STD), when will my Paid Family Leave (PFL) begin?

When you are no longer disabled by pregnancy and are ready to begin bonding, you may establish your PFL claim.

PFL may be taken in one continuous leave or intermittently (in one day increments) within the first 12 months after your child’s birth.

 

Care of Family Member Scenarios

My child is scheduled for surgery mid-year, and I will need four weeks to care for them. Would the Paid Family Leave (PFL) benefit cover this and still allow me to use the remaining four weeks later in the year?

Yes. If you are currently enrolled, in this scenario, the surgery date is the “qualifying event”. You can use up to 8 weeks – continuously or intermittently – of PFL within 12 months for multiple qualifying events.

My sibling is planning to begin chemotherapy and the physician said he will require assistance. Would the Paid Family Leave (PFL) benefit cover this?

Yes. If you are currently enrolled.

PFL benefits will cover your time to care for a seriously ill family member (child, parent, parent-in-law, grandparent, grandchild, grandchild, sibling, spouse, or registered domestic partner).

The benefit may cover care of a patient that requires:

  • At-home care or in-patient care in a hospital, hospice, or residential medical care facility.
  • Continuing treatment by a physician or health care practitioner.

Intermittent Leave

How is Paid Family Leave (PFL) paid out when taking intermittent leave?

The County of San Diego plan is set up to mimic the State of California's process it at 1/7, or a 7-day work week.  Meaning your weekly pay is divided by 1/7 so it’s based on a full week’s calendar day calculation. Weekends are included in the weekly calculation of PFL. Your paid time may stop sooner, however; you will not lose any payment benefit because of the 1/7 calculation. You will still reap the same overall benefit from the plan.

Am I losing Paid Family Leave (PFL) pay when taking intermittent leave?

No. You’ll be eligible for 8 weeks of paid time off divided by seven days rather than a five-day work week.  Please make sure and reach out to your Lincoln claims adjuster for additional information on how your payment will be calculated.

Would you provide an example of the calculation?

You can find a calculator here: Lincoln Benefit Calculator (must be on County network to access)

 

Beginning Your Leave of Absence

How and where do I start the leave process?

All Leaves of Absence (LOA) begin with your department.  Please reach out to your Department Human Resources Officer (DHRO) DHRO Contact List (must be on County network to access) or Department Leave Coordinator for assistance.

What resources are available to help me understand the leave of absence process?

Please review our Employee Checklist for Leaves of Absence in the LOA Toolkit (must be on County network to access). The Checklist contains helpful tips and items to discuss with your Department Human Resources Officer (DHRO), who will guide you through the leave process.

 

Buyback Process

When will the buyback process start if I’m paid over 100% of my salary?

The Benefits department does not administer buyback, that is done exclusively through the Central Payroll Administration CentralPayroll@sdcounty.ca.gov or 858-694-2051.

Integration/buyback will begin when three things occur:

  • Central Payroll Administration receives notification of Short-Term Disability (STD), Paid Family Leave (PFL) or Long-Term Disability (LTD) payments from Lincoln Financial.
  • Central Payroll Administration receives a copy of the State Disability Insurance (SDI) or Paid Family Leave (PFL) benefit statements.
  • Central Payroll Administration staff have calculated the amount to be integrated.
  • The employee is in a paid status sufficient to cover normal deductions and the deduction for the amount being integrated.  IF you are not using leave balances, you will be on unpaid status, which eliminates the potential for buyback.

Please see more buyback FAQ’s Integration_Buyback_FAQ (must be on County network to access)  

 

Abbreviations:

STD = Short-Term Disability

PFL = Paid Family Leave

FMLA = Family Medical Leave Act

CFRA = California Family Rights Act

CA SDI = California State Disability Insurance

EDD = Employment Development Department