Yes. Sun Life offers both fully insured and self-insured equivalent plan administration for employers.

Employers: All private employers, state agencies and local governmental agencies must provide PFML insurance for their employee.

Self-employed individuals and Tribal Governments can elect coverage.

Employees:

Any employee working in the state of Oregon is eligible for benefits under the OR PFML law if they have earned at least $1,000 in wages during the base year. If an employee has not earned $1,000 in wages during the base year, employees may be eligible if they have earned at least $1,000 in wages during the alternate base year.

Base year means the first 4 of the last 5 completed calendar quarters preceding the benefit year.

Alternate base year means the last 4 completed calendar quarters preceding the benefit year.

Benefit amounts are based on an employees’ total wages with each employer.

• Two-Tiered Benefit Calculation:
  • 100% of the employee’s Average Weekly Wages (AWW) for wages up to 65% of the State Average Weekly Wage (SAWW);
  • any amount of the employee’s wage that exceeds 65% of the SAWW will be paid at 65% of the SAWW plus 50% of the amount earned over 65% of the SAWW.
• AWW is employee’s total wages paid during the base year divided by the number of weeks in the base year.
  • “Base year” is first 4 of last 5 completed calendar quarters.
  •  “Alternate Base year” is the last 4 completed calendar quarters preceding the Benefit year.

The maximum weekly benefit is 120% of the SAWW which will be adjusted once per year. 

The minimum weekly benefit is 5% of the SAWW which will be adjusted once per year.

Eligible employees may take up to 12 weeks in a benefit year to care for themselves or a family member, and up to 2 additional weeks for pregnancy, childbirth, or related circumstances. 

No, there is no waiting period for benefits.

Medical leave is available due to employee’s own serious health condition*, including leaves for organ or body part donation.

Family leave is available to an employee:

• To bond with a covered individual’s child during the first 12 months after the child’s birth, or placement of a child under 18 years of age.
• To care for a family member with a serious health condition.

Safe leave is available when needed due to Domestic Violence, Sexual Assault, Harassment, a Bias Crime or Stalking:

• To seek legal or law enforcement support to ensure the health and safety of the employee or the employee’s minor child or dependent, including preparing for and participating in protective order, civil, or criminal proceedings.
• To seek medical treatment for, or to recover from, injuries to employee or the employee’s minor child or dependent.
• To obtain, or to assist a minor child or dependent in obtaining, counseling from a licensed mental health professional.
• To obtain services from a victim services provider for the eligible employee or the employee’s minor child or dependent.
• To relocate or take steps to secure an existing home to ensure the health and safety of the eligible employee or the employee’s minor child or dependent.

*The definition of serious health condition aligns with that under the federal FMLA. Namely, a serious health condition is an illness, injury, impairment or physical or mental condition involving inpatient care or continuing treatment.

Covered family members include a child, grandchild, grandparent, parent, sibling, spouse or domestic partner, or any individual who has a familial relationship with the employee. 

To be eligible for job protection, the employee must have been employed for the employer for at least 90 days before taking leave under OR PFML.

For employers that employ fewer than 25 employees, if the position held by an eligible employee when the employee’s leave commenced no longer exists, an employer may, at the employer’s discretion based on business necessity, restore the eligible employee to a different position with similar job duties and with the same employment benefits and pay.

Yes, intermittent leave can be taken on a 1 work day or 1 work week basis. The definition of a "work day" in Oregon means any day on which the employee performs any work for an employer and is an increment of a work week. It is not defined as a specific number of hours.

The Paid Leave Oregon state plan is funded through a payroll-based contribution. For 2023, the rate is 1% of up to $132,900 in wages. Effective January 1, 2024, contributions will be subject to the Social Security Wage Cap of $168,600.

• Employees pay 60% of that rate.
• Employers pay 40% unless they have fewer than 25 total nation-wide employees (i.e., categorized as a small employer)
• Fewer than 25 nationwide employees: The employer is not required to contribute. If the employer chooses to contribute and pays for at least 8 quarters, the employer secures their right to access certain grant money to be used in the event of employee leave.

A replacement worker who is hired to temporarily replace an employee on OR PFML leave will not be counted as an employee in determining the number of employees working for an employer.

Employers are able to apply for an equivalent plan via the state's online portal, Frances Online. An employer may apply for approval of a self-administered or fully insured equivalent plan..

An employer seeking approval for a fully insured plan will be required to submit an application to the Director accompanied by an issued policy (or confirmation of insurance form), and an application fee of $250. Applications for a self-insured plan must be accompanied by proof of solvency, a Summary Plan Description and the application fee of $250.

Only after receiving approval of an application from the state of OR will the employer not be required to remit employer or employee contributions to the state plan.

• The employer may deduct employee contributions to fund an equivalent plan, provided the contributions do not exceed the amount the employee would remit under the state plan. Any contributions taken by the employer to fund an equivalent plan must be used for plan expenses and are not considered employer assets.

Employers offering equivalent plans are required to meet reporting, notice, records, job protection and benefits continuation requirements.

Equivalent plans must remain in effect for a minimum of one year. Employers will be required to reapply once per year for three years following the initial approval of an equivalent plan. The cost for renewal each year has been set at $150. Thereafter, reapproval is required only for plan changes.

The Federal FMLA permits employers to choose from 1 of 4 leave year methods. Oregon PFML requires the use of the rolling forward 52-week period starting from the Sunday prior to the leave.

Example: If an employee goes out on leave on 9/21/23, their benefit year begins 9/17/23 (the Sunday prior to the leave start date) and ends on 9/16/24. The 12-week allotment is used during this time.

Yes, employers must maintain any healthcare benefits the employee had prior to taking leave for the duration of the leave. The employer can require that the employee pay their share of healthcare premiums while on leave.

No. Generally, Short Term Disability policies are not the same as OR PFML plans and cannot be used as an equivalent plan. 

Yes. While the OR PFML law creates certain paid benefits for leave because of an employee’s own health condition or for covered caregiving reasons, the OR PFML law is not intended to replace benefits provided by employers through Short-Term Disability (STD) plans and programs. It is important to know that cancelling STD benefits could leave your employees unprotected if they become disabled for these reasons:

1. Benefit amount for higher-income employees. The OR PFML max weekly benefit may be insufficient for high-income earners who require greater income replacement.
2. Consequences of combined 12 weeks of family and medical leave. If an employee takes 12 weeks of family leave in a 12-month period, the employee may be left without income replacement for their own serious health condition in the same timeframe.
3. Impact of intermittent leave. OR PFML can be taken intermittently so an employee may substantially reduce and/or exhaust their benefits and be left without income replacement protection if they become seriously and continuously disabled thereafter.
4. Short-Term Disability may offer additional features and benefits. STD policies may include employee-facing features that improve their experience: first-day hospitalization, survivor benefits, and, most importantly, return-to-work and vocational rehabilitation programs. Employees can still access these features even if they are approved for both OR PFML and STD.

Sometimes when benefits are payable for an employee’s own serious health condition under OR PFML that condition may also meet the criteria as “Disabled” that is in their Short-Term Disability plan. If the situation meets the conditions of both programs, the Short-Term Disability benefit payment may be offset, or reduced, by any OR PFML benefit payments for the same condition, and the leaves will run concurrently.

OFLA and OR PFML are 2 different laws with different eligibility thresholds, leave reasons, and applicability. Sometimes the employee qualifies for leave under one program and not the other. When the leave is covered under both, the leave under each will run concurrently.

Sun Life reviews the Short-Term Disability rates for inforce clients on an annual basis to ensure they are appropriate. Due to the new offset for Oregon PFML benefits, we anticipate that clients with a Sun Life Short-Term Disability program and a high percentage of workers in Oregon, will need their Short-Term Disability rates adjusted. This adjustment will be determined and communicated to our clients as close to the start of the Oregon PFML program date as possible.

This decision may be based on many factors, including cost, ease of claimant experience, and placement of Short-Term Disability or other leave programs. Please consult your insurance broker for the best approach for your company.