New York PFL Leave Process

The below tables describe the process of an employee gaining access to paid family leave.

Leave Process

New York Paid Family Leave (PFL): Bonding (no disability for maternity), care for family member, military exigency leaves
Intake process Obtaining proof Once decision reached Payments
Employee Reports request for New York PFL to Cigna Intake Center (telephonic or paper). Employee receives acknowledgment with PFL-1, direct deposit request form and any required certification form(s).

Employee returns completed forms to Cigna.

If claim documentation is incomplete, employee receives specific instructions on how to correct.

Employee receives determination notice.

If request is for intermittent leave, employee receives instructions for reporting time off requests.

If request denied, employee receives correspondence explaining specific reasons(s) and instructions for appealing decision.

Employee receives benefits weekly via check or direct deposit

Benefits for intermittent time off will be paid as time off is reported.

Cigna Team Sends acknowledgment letter, PFL-1, and any required certification form(s) and direct deposit request form to employee. Cigna ensures claim information is complete. The form(s) will be returned to employee within 5 business days with specific instructions if there's missing information needed to make a determination.

Cigna may request eligibility information from employer.

Cigna reviews information received within 5 business days.

If approved, Cigna sends approval letter to employee. Cigna determines available PFL entitlement according to prior DBL usage and calculates weekly benefit rate.

If request is for intermittent leave, specific instructions are provided to employee for reporting time off requests.

If request is denied, Cigna sends denial notice with specific reason(s) for denial and instructions for appealing decision.

Employee receives benefits weekly via check or direct deposit.

Benefits for intermittent time off will be paid as time off is reported.

Employer Employer may receive request for eligibility information. If needed, employer provides eligibility information within 3 business days of receiving request Employer receives reports. Cigna may release benefits to employer for salary continuance reimbursement.
New York Paid Family Leave (PFL) + Disability Benefits Law (DBL): Pregnancy/maternity with bonding
Intake process Obtaining proof Once decision reached Payments
Employee Reports request for New York PFL to Cigna Intake Center (telephonic or paper) Employee receives acknowledgment with PFL-1, direct deposit request form, and any required certification form(s).

Employee returns completed forms to Cigna

If claim documentation is incomplete, employee receives specific instructions on how to correct.

Employee receives separate approval notices for maternity (disability) and bonding (PFL) requests.

If request, or a portion thereof, is denied, employee receives notice of denial (DB451 for maternity and/or specific reason(s) outlined for PFL) and instructions for appealing decision(s)

Employee receives benefits weekly via

Benefits for intermittent time off will be paid as time off is reported.

Cigna Team Sends acknowledgment letter, PFL-1 and any required certification form(s) and direct deposit request form to employee.

Call out is made to determine if employee wants to start bonding leave immediately following DBL claim.

Cigna ensures claim information is complete. The form(s) will be returned to employee within 5 business days with specific instructions if there's missing information needed to make a determination.

Cigna will review information received within 5 business days.

Cigna may use approval of disability benefits for birth in lieu of the Bonding Certification (Form PFL-2).

If approved, Cigna sends approval letter to employee. Cigna determines available PFL entitlement according to prior DBL usage and calculates weekly benefit rate.

If request is denied, Cigna sends denial letter with specific reason(s) for denial and instructions for appealing decision.

Cigna calculates weekly benefit and issues weekly benefits via check or direct deposit.

Intermittent absences are tracked and benefits are released as time off requests are received.

Employer Employer may receive request for eligibility information. If needed, employer provides eligibility information within 3 business days of receiving the request. Employer receives reports. Cigna may release benefits to employer for salary continuance reimbursement.
New York Paid Family Leave (PFL) + Family and Medical Leave Act (FMLA): Includes coordination with prior New York DBL time and/or pregnancy disability benefits
Intake process Obtaining proof Once decision reached Payments
Employee Reports request for New York PFL to Cigna Intake Center (telephonic or paper) Employee receives eligibility notice for FMLA and a separate PFL acknowledgment with PFL-1, direct deposit request form and any required certification form(s).

Employee returns completed forms to Cigna

If claim documentation is incomplete, employee receives specific instructions on how to correct.

Employee receives FMLA determination notice. A separate determination notice will be issued for PFL.

If request is for intermittent leave, employee receives instructions for reporting time off requests

If PFL request is denied, employee receives separate letter with reason(s) for denial and instructions for appealing decision.

 

Employee receives benefits weekly via check or direct deposit.

Benefits for intermittent time off will be paid as time off is reported.

Cigna Team Sends acknowledgment letter, PFL-1 and any required certification form(s) and direct deposit request form to employee.

Call out is made to determine if employee wants to start bonding leave immediately following DBL claim

Cigna ensures claim information is complete. The form(s) will be returned to employee within 5 business days with specific instructions if there's missing information needed to make a determination.

Cigna will review information received within 5 business days.

Cigna may use approval of disability benefits for birth in lieu of the Bonding Certification (Form PFL-2).

FMLA certification will stand proxy for PFL-1 if sufficient information is received to expedite claim process.

If PFL is approved, Cigna sends separate PFL approval letter to employee. FMLA leave status will be communicated separately.

Cigna determines available PFL entitlement according to prior DBL usage and calculates weekly benefit rate

If PFL is denied, Cigna sends denial notice with specific reason(s) for denial and instructions for appealing decision.

 

Cigna calculates weekly benefit and issues weekly benefits via check or direct deposit

Intermittent absences are tracked and benefits are released as time off requests are received.

Employer Employer may receive request for eligibility information. If needed, employer provides eligibility information within 3 business days of receiving the request. Employer receives reports. Cigna may release benefits to employer for salary continuance reimbursement.
New York Paid Family Leave (PFL) + intermittent leave: Time reporting process (includes coordination with FMLA)
Intake process Obtaining proof Payments
Employee Employee notifies employer of need for time off according to their employer's time off policy.

Employee reports time off request to Cigna via phone.

Employee receives real time verbal notification if time requested is approved or denied

If additional information is required, employee receives explanation of next steps

Employee receives benefits as time off is reported via check or direct deposit.
Cigna Team Reviews time off request against certification information to determine if absence can be approved. If absence reported falls within the certification, absence is approved.

If absence is outside of the certification, this is explained to the employee, the absence is pended and new/updated certification is requested.

If absence is denied, reason is explained to employee and a denial notification is sent that includes arbitration language.

NOTE: there may be absences that can be approved for one plan and not the other. For example, an absence of a partial day would not be approved for New York PFL but could be approved for FML.

Cigna calculates daily benefit and issues via check or direct deposit.

Intermittent absences are tracked and benefits are released as time off requests are received.

Employer Employer may report time off requests on behalf of employee. Employer receives information about time off requests via reports. Employer receives information about payments via reports.